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medical measures are ineffective. Portal-systemic shunting has been helpful at controlling ascites, and is now usually performed as a TIPSS procedure. Shunts between the peritoneal cavity and the systemic venous system have been created surgically for over 30 years, and can provide excellent relief from ascites refractory to other treatment, but complications are multiple, including infection, blockage of shunt, and disseminated intravascular coagulation, and such shunts are now performed rarely.

Operating on patients with portal hypertension is technically challenging, as multiple dilated veins are found within the abdomen, making surgery difficult, bloody and slow. These dilated veins do not seal well with diathermy, and suturing of bleeding points is often the best course of action.

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