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John Terblanche, ChM
Cape Town, South Africa

Arch Surg. 2000;135:1394.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The authors are to be congratulated on their excellent documentation of the 50-year evolution of portal hypertension surgery in their unit. They have performed 1000 operations. For elective long-term management, they currently favor portal flow–preserving procedures, particularly the distal splenorenal shunt, and when not possible, an extensive 2-stage Sugiura devascularization operation. They have abandoned emergency shunt surgery for acute variceal bleeding.

They do not document which patients should be selected for endoscopic therapy rather than surgery nor the number of similar good-risk patients who were treated by endoscopic therapy at their institution. Even though the article is an analysis of their surgical experience, the role of nonsurgical therapy needs to be clarified.

We believe that endoscopic therapy or drugs (propranolol and nitrites) should be the primary therapy for all patients. We favor endoscopic therapy using sclerotherapy or banding. Only when endoscopic therapy fails should surgical procedures be . . . [Full Text of this Article]

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The Evolution of Portal Hypertension Surgery: Lessons From 1000 Operations and 50 Years' Experience
Héctor Orozco and Miguel Angel Mercado
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