Analysis of 40 cases of portal hypertension operated on by portal systemic shunt at the Department of Surgery, Medical College of Yonsei University, from October 1961 to June 1974, obtained following results.
1. Among 40 cases, males were 36, females were 4 cases, and average age was in 3rd and 4th decades.
2. The cause of portal hypertension was due to liver cirrhosis in all cases. Liver biopsy was carried out in 25 cases. Among them, the postnecrotic type of cirrhosis was 15 cases (60%) comparing 7 cases(28%) of portal or Laennec type cirrhosis.
3. The clinical and laboratory findings of these patients were splenomegaly 32(80%) bleeding 28(70%), and ascites 23(57.5%) in descending order. The- splengmegaly with hyper-splenism(28 cases; 70%) was another characteristic clinical findings with postnecrotic type of cirrhosis proved by liver biopsy.
4. We performed side to side portacaval shunt in 19 cases, splenorenal shunt with splenec-tomy in 20 cases, and end to side portacaval shunt in one case, The emergency transesopha-geal varix ligation was performed in two cases of variceal bleeding before and after shunt state.
5. The over all operative mortality was 3 cases (7.5%). Portal vein pressure ranged 250 to 490mm saline.(mean; 369mm saline) There were no pressure drop difference between side to side portacaval shunt(mean; 120mm saline) and splenorenal shunt with splenectomy(mean; 117 mm saline) (t=0.107, p>0.40)
6. The major complications related to shunt surgery were as following; encephalopathy 10 cases (25%), rebleeding in 6 cases (15%), hunger pain in 3 cases, and hepatorenal syndrome in 2 cases.
7. Twenty-three patients (57.5%) were postoperatively followed up, and analyzed as follow.
g) Clinically one who had severe hepatomegaly, intractable ascites, hepatic coma, and glomerulonephritis showed poor prognosis after surgery.
B) There was no difference in incidence of rebleeding between side to side portacaval shunt and splenorenal shunt with splenectomy, but the patients underwent side to side portacaval shunt had much higher incidence of post operative encephalopathy and lower survival rate at the end of one year.
C) According to Child´s classification, all cases belonged to group B and C. Although higher operative mortality (20%) and poor survival rate (one third within one year) in Child´s C group, about one third of them living 3 years or more.
D) Emergency shunt performed in 12 cases, elective shunt in 15 cases, and prophylactic shunt in 13 cases. As the most of prophylactic shunts were performed in early 1960, satisfactory follow up was not available.
Although the experiences were too small to make a conclusion, long term survival after emergency shunt was quite enthusiastic. This finding suggests that time-consuming conservative care and/or unnecessary observation until bleeding stop might lose the better chance of surgery.
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