[Surgical treatment of cavernomas of the portal vein. 56 cases, including 42 operated cases].

The difficulty of surgical treatment of cavernomas of the portal vein results from the anatomical conditions created by this type of portal hypertension, in spite of favourable physiological conditions due to the integrity of the hepatic parenchyma. The latter is, in fact, relative after a certain length of history. This erratic course renders difficult assessment of the efficacy of methods of treatment. In the light of 56 cases, including 42 operated cases, the authors present the indications for surgery which depend on the severity and frequency of hemorrhage and also on the patient's age. When repeated bleeding occurs, a by-pass should be attempted whenever possible, if the bleeding impedes social life or growth, or if it threatens life. Mesenterico-caval anastomosis is preferable before the age of 7 years. Spleno-renal anastomosis requires a sufficient size of splenic vein. Ligature of aesophageal varices or disconnection of the oesophagus from the stomach, may be considered in cases of moderate hemorrhage. The varices may be treated by sclerosing injections after failure of a by-pass operation or in inoperable patients. Oesophago-gastrectomy is useful but should be a last resort.