Surgical Techniques Illustrated Summer 1980 [antikvár]

End-to-Side Portacaval William P. Mikkelsen, M.D. Anastnmnsis Clinical Professor of Surgery, University of Southern California School of Medicine; Chairman, Department of Surgery, Hospital of the Good Samaritan, Los Angeles, California Illustrated by Frank Robinson On the basis of several clinical and hemodynamic reports from our liver group at the University of Southern California In Los Angeles [1-3], the end-to-slde portacaval anastomosis Is believed to be physiologically superior to the slde-to-side anastomosis. As a dividend, the end-to-slde shunt Is technically easier to construct in most patients. Other portasystemic shunts are physiological variants of the slde-to-side portacaval shunt. These Include the mesocaval "H graft" and the central and standard splenorenal, portorenal, and renomesenterlc shunts. All are satisfactory under a given set of circumstances, but all are probably somewhat Inferior to the standard end-to-slde portacaval shunt In the majority of patients. Although more than ten years have elapsed since Warren Introduced the distal selective splenorenal shunt, Its final role In the management of portal hypertension remains to be determined. Its principal disadvantage Is Its technical difficulty, which must be overcome by each surgeon individually, and, unfortunately, at the expense of a few patients. References 1. Iwatsukl, S., Mikkelsen, W. P., Redeker, A. G„ Reynolds, T. B„ and Turrlll, F. L. Clinical comparison of the end to side and side to side portacaval shunt: Ten year follow-up. Ann Surg 178:65, 1973. 2. Mikkelsen, W. P., Turrlll, F. L„ and Pattl-son, A. C. Portacaval shunt In cirrhosis: Clinical and hemodynamic aspects. Am J Surg 104:204, 1962. 3. Reynolds, T. B„ Hudson, N. M„ Mikkelsen, W. P., Turrlll, F. L„ and Redeker, A. G. Clinical comparison of end to side and side to side portacaval shunt. N Engl J Med 274:706, 1966.