Small diameter porta-caval shunt with ringed PTFE prosthesis for the treatment of portal hypertension

Abstract

Surgery should still play a major role for bleedings due to portal hypertension, even if the majority of patients at first have been treated endoscopically with sclerotherapy or elastic band ligation of the oesophageal varices. Porto-systemic shunts are more effective for the overall therapy of oesophageal varices than other procedures as oesophageal transection, sclerotherapy or elastic band ligation [1–3], even if encephalopathy and hepatic failure often are major drawbacks. Selective shunts were thought to affect liver function less than non-selective shunts [5,11], but they appeared, in the long run, to be as associated as the nonselective ones to a similar incidence of encephalopathy [15]. Recently Sarfeh and co-workers [54,55] pointed out that the use of partial shunts revealed a lower incidence of encephalopathy than the total shunts, because of the preservation of a hepatopethal flow, thus avoiding liver failure [16].