[Splenic transposition for portal hypertension (author's transl)]. / Intrathorakale und andere Milzverlagerungen bei Pfortaderstauung.

Operative techniques for splenic transposition are reviewed and operative indications discussed. Thoracic transposition of the spleen for treatment of oesophageal bleeding is indicated in children and in patients with portal thrombosis and, in addition, in cases of intractable ascites complicating posthepatic obstruction. Late results of 28 cirrhotics operated on after variceal bleedings are presented. Fatal bleeding recurrences were avoided in 83 per cent of the cases surviving six months and the mean survival is 7.5 years so far. In elective surgery of cirrhotics with well maintained portal flow the most rational operative procedures are distal spleno-renal shunt and thoracic transposition of the spleen.

The treatment of acute cholecystitis. A series of 497 consecutive patients.

In a five-year series of 497 consecutive patients with acute cholecystitis an overall mortality of 3.2% was observed. There was no significant difference in mortality between patients undergoing early surgery and those managed initially conservatively. The total incidence of postoperative complications was also similar in the early and delayed surgery groups, although wound complications were slightly more frequent after early surgery. A special risk group was formed by patients with unsuccessful conservative treatment demanding emergency surgery later. These delayed emergency cases contributed half of the deaths; the mortality was 28% in this group. Conservative initial treatment was followed by a recurrence rate of 21% before delayed surgery undertaken on average four months after the acute episode. With early surgery for acute cholecystitis recurrence and later emergencies can be avoided and the time of treatment approximately halved without significant increase in operative risks compared with delayed surgery. The data obtained under routine clinical work support the results of the prospective trial carried out at the same department of surgery (Järvinen & Hästbacka, 1979).