title: Portal hypertension: surgical management in the 1990s.
abstract: BACKGROUND
  Although liver transplantation offers definitive treatment for portal hypertension with end-stage liver failure, surgical portosystemic shunts avoid the risks of transplantation and immunosuppressive therapy, and transjugular intrahepatic portosystemic shunt (TIPS) creates a portosystemic shunt with minimal operative risk. The appropriate applications of these modalities are discussed.
  
  
  METHODS
  All adults undergoing primary liver transplantation alone (PLT, n = 265), PLT after TIPS (n = 34), PLT after surgical shunts (n = 12), surgical shunt alone (n = 13), TIPS alone (n = 35), or surgical shunt after PLT (n = 5) served as the basis of this study.
  
  
  RESULTS
  In contrast to surgical shunts before PLT, TIPS before PLT increased the 1-year graft survival. Surgical shunts alone were done in 18 patients with normal or near normal liver function with 100% survival. TIPS alone offered effective symptomatic relief to most patients, all of whom were judged not to be surgical candidates.
  
  
  CONCLUSIONS
  TIPS, surgical shunts, and liver transplantation each have a logical role in management of portal hypertension. Surgical candidates with Child's B or C liver failure should be treated with liver transplantation, and TIPS offers effective treatment for nonsurgical candidates. Surgical shunts can be performed with excellent results in patients with Child's A liver disease. Portal vein occlusion with normal liver function can be successfully treated with surgical shunts.
authors.affiliation: Department of Surgery, University of Wisconsin Medical School, Madison.
authors.forename: S J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: M
authors.initials: M
authors.lastname: Kalayoglu
authors.forename: A M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: J D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: M J
authors.initials: MJ
authors.lastname: Armbrust
authors.forename: I A
authors.initials: IA
authors.lastname: Sproat
authors.forename: M M
authors.initials: MM
authors.lastname: Wojtowycz
authors.forename: J C
authors.initials: JC
authors.lastname: McDermott
authors.forename: A B
authors.initials: AB
authors.lastname: Crummy
authors.forename: F O
authors.initials: FO
authors.lastname: Belzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical