Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy ( ) in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone ( ). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension. 1. Introduction Portal hypertension substantially affects the patient quality of life and leads to high mortality. In developing countries, the incidence of portal hypertension is significantly higher than that in developed countries [1]. Recurrent variceal hemorrhage and hepatic failure are common causes of death in these patients. About one-third of patients with liver cirrhosis and varices experience hemorrhages [2]. The mortality due to first variceal bleeding can be as high as 30–50% [3]. The following treatment options are currently available for this disease. Nonselective -blockers and endoscopic variceal ligation have been utilized to prevent first variceal hemorrhage. A recent meta-analysis on nonselective -blockers demonstrated that these drugs reduce rebleeding and increase survival [4]. However, only one-third of patients have hepatic venous pressure gradient (HVPG) response while on beta-blockers [5]. Currently, the safest method to treat acute bleeding from uncomplicated gastroesophageal varices is endoscopic sclerotherapy [6]. Unfortunately, this method does not reduce the bleeding risk in patients with accompanying liver cirrhosis [6]. Further, sclerotherapy is not effective for primary prevention of variceal
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