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I have particular pleasure in introducing this publication by Gian
Pietro Marzoli and Sergio Vesentini. Years ago they
enthusiastically accepted my suggestion that they should take
specific interest in the clinical and surgical problem of portal
hypertension, and assess the proposals of surgical ex- perience
with regard to this debated physiopathological picture. These
thanks are all the more real because in this way the school's
attention remained fixed on a subject that had already attracted it
profoundly from the start - with Giovanni Castiglioni and Vittorio
Pettinari as heads of the school - and then threatened to die away
into general con- formism. In Italy "precariousness" is easily
extended to the concept of school continuity. In Warren's proposal
(1967) of "distal splenorenal anas- tomosis with disconnection of
the spleno-oesophageal from the mesenteric district", I felt there
was an intelligent at- tempt to solve all the basic problems,
albeit in different ways. An attempt, that is to say, at
alleviating the gastro- oesophageal circulation, thus avoiding*
haemorrhage, and at ensuring that the liver would maintain the
circulatory ef- ficiency with which it was still endowed. The
spleen was re- tained, but there was reason to think that, by
reducing blood stasis within its ambit, it would be possible to
manage or alleviate any hypersplenism: not an absurd hypothesis if
the Americans had sometimes noted in their material function- al
and even anatomical reversion of the splenopathy after a simple
portacaval shunt.
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