Surgical portosystemic shunting

When all else fails to stop recurrent variceal bleeding, and when hepatic function and nutrition are not extremely impaired, one can resort to intrabdominal portosystemic shunting operations. One study demonstrated that, when abstinence from alcohol is assured and protein intake is regulated sufficiently well to avoid episodes of hepatic encephalopathy, 67 per cent of 220 mainly alcoholic cirrhotics survived for at least 10 years after emergency shunting, 70 per cent had improved hepatic blood tests, and only 8 per cent had recurrent portosystemic encephalopathy ( OfJofjelML 1994). These results were achieved by a very experienced group, and may not be applicable in hospitals with less experience.

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