Operations for portal hypertension in China

Y. T. Huang

Portal hypertension is common in China. There have been 3,500 surgically treated cases reported since 1978. Of these, 97.8% were intrahepatic, of which 49.1% were postnecrotic cirrhosis and 41.0% were schistosomatic. Portosystemic shunting was performed in 59.9% of the cases and portacaval shunting was performed in one third, with an operative mortality of 0% to 7%. The rebleeding rate was 4.0% to 24.1%. The five-year or greater survival rate was 63.8% to 83.0%. The rate of portal-azygous disconnection surgery has increased in recent years, constituting 40.1% of the various types of operation. In contrast with the viewpoint in Western countries, prophylactic operation is available. When treating acute bleeding, most authors have preferred nonoperative treatment, but operation should not be delayed if this fails. The operative mortality of patients undergoing emergency portosystemic shunting was 16% to 44%; in patients undergoing portalazygous disconnection it was 7.1% to 44.3%.