[Interdisciplinary management of portal hypertension: status of portosystemic shunt operations].

Decompressive portosystemic shunt operations continue to be part of the therapeutic concept for hemorhaging of esophageal varices inspite of endoscopic scelerotherapy and TIPS. Discussion of the different surgical indications, in particular for the emergency shunt. Analysis of our own patients. From 1970-1992 we saw 928 patients with bleeding varices, 755 operations were performed due to variceal bleeding, of these 686 portosystemic shunts and 69 disconnection operations. In 546 (79.5%) patients a portocaval anastomosis was performed, of which 356 (65.2%) being emergency or early operations and 190 (34.8%) elective operations. The mortality, dependent on the degree of hemorrhaging and the number of previous recurrent bleedings, could be drastically reduced inspite of a broad indication: to 33% in emergency shunts, to 6% in elective shunts, to 0% in stage Child A since 1980. In stage Child C, the Warren shunt is preferred. The rate of encephalopathy: 12% latent and reversible, 12% chronic (alcoholics). Late mortality is dependent on the status of liver cirrhosis and on alcohol abstinence. The 5- and 10-year expected survival rates are 72% or 39% in abstinent patients, and in non-abstinent patients 36% or 0%, respectively.