J.Jpn. Surg. Soc.. 79(12): 1481-1488, 1978

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Original article

STUDY ON PORTAL HYPERTENSION

Reviewing recent literatures, it is obvious that the shunt operations for esophageal varices are not so superior as has been thought in these three decades and more reliable methods of therapy are under search by many investigators. I have pointed out that the etiology of producing esophageal varices may not be so simple as has been thought and the hyperdynamic state of portal circulation, which is established in portal hypertension, may play an implrtant role on the etiology.
Basic thought for getting more reliable and safer method for esophageal varices in cirrhosis of the liver consists of the method in which the portal prsusre is not lowered after the operation. There are two ways for realizing this thought : (1) selective shunt method (2) extensive devascularization and disconnection method. Regardng the former, I devised a left gastric venacaval shunt which diverts the blood from the esopahgeal varices through a left gastric vein. As to the latter, I analyzed the necessary condition required for satisfactory abolishment of esophageal varices and reached a way transthoracophrenic infraesophagosupragastic devascularization with esophageal transection with preservation of hiatal structure.

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