Portal hypertention among koreans differ from that of American population in many aspects, notably in pathogenesis and presenting symptoms. These facts must be reflected in selecting the type of treatment to be given. Because of the following reasons, splenectomy with spleno-renal shunt appears to be the procedure of choice in the treatment of portal hypertention among korean population.
1) Portal vein thrombosis is a frequent cause of portal hypertention.
2) Because of the unique presence of huge spleen in those patients, the size of splenic vein is
almost always adequate and fall in pressure following shunt is usually sufficient.
3) Causative liver disease in those patients is bizarre and unstable, and the effect of shunting
upon liver is smaller following spleno-renal shunt than direct porta-caval shunt.
4) Incidence of portal-systemic encephalopathy is much more higher following; direct porta-caval
shunt partly due to the fact that the causative liver disease is far more advanced and hepatic
functional reserve limited.
5) Although the length of follow up period is too short, out of 19 shunt surgery survivors, there was not a single recurrent bleeding episode reported although the same patients bled ´´I total of more than 35 times preoperatively during comparable length of time. 14 of these received spleno-renal shunt.
6) Improvement in the picture of hypersplenism following porta-caval shunt is quite invariable while results are more consistent following spleno-renal shunt.
Although this type of surgery should be reserved to those who have bled from their esophagogastric varicies, the operation should be offered to those who present themselves ith massive splenomegaly and hypersplenism without a history of previosw variceal bleeding. These ecommendatiop is based on the clinical observation, pre-and and post-operative hepatic blood fib studies and blood chemical studies on 20 patients who had undergone shunt surgery up to 2 years´ prior to this report. They had shown little deleterious effect upon their liver.
Properly performed, ammonium tolerance. test can be utilized. , in confirming the patency of the shunt previously performed.
It is stressed that the most important key to the success in this type of surgery remain to be the selection of patients and timing in relation to the natural course of the disease. A mortality seldom: originate within the operating suite.
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