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J. Michael Henderson, MD
Cleveland, Ohio

Arch Surg. 2002;137:1130.

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

Is there any role for surgical decompression in treating variceal bleeding? This question is frequently asked because there are now many other options. Pharmacologic and endoscopic therapies are optimal first-line treatments, TIPS has been widely applied to decompress portal hypertension, and liver transplantation for end-stage liver disease is used to treat a significant number of patients with variceal bleeding. The authors of this article show that for a population of patients in the Pacific Islands, surgical decompression of varices provided good therapy for variceal bleeding.

What lessons are there to learn from this paper? There are 2 dominant messages: (1) Medically, the authors show that surgical shunt can be a good treatment for variceal bleeding, and (2) sociologically, they show that for patients who are noncompliant with medical care, surgical shunt is a good option. After considering the medical issues, the authors chose to perform distal . . . [Full Text of this Article]

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