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One hundred consecutive Child's A or B patients with portal hypertension who survived the index episode of variceal bleeding were electively treated by a distal splenorenal shunt modified by a retroperitoneal approach. The operative mortality of the whole series was 11 per cent, but fell from 16 per cent in the first 50 patients to 6 per cent in the second half of the series. The median survival probability (68 months) and the 5 year survival rate (52 per cent) of Child's A patients differed significantly from those of Child's B patients (8 months and 15 per cent respectively; P less than 0.001). The probabilities of freedom from rebleeding and hepatic encephalopathy at 5 years were also significantly greater in Child's A patients (70 per cent and 70 per cent respectively) than Child's B patients (25 per cent and 30 per cent respectively). These results suggest that the modified distal splenorenal shunt is an effective and relatively safe procedure for the elective treatment of variceal bleeding in Child-Campbell 'A' patients but that patients in group B should be considered for other forms of therapy.

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