11.   The options available for the surgical treatment of variceal haemorrhage during or after sclerotherapy now include hepatic transplantation as well as devascularisation or portosystemic shunting.

12.   All patients admitted with their first variceal haemorrhage were resuscitated and treated by urgent endoscopic sclerotherapy.

13.   In addition the failure of surgery and sclerotherapy was assessed in terms of recurring variceal haemorrhage and the need to resort to alternative measures in order to control it.

14.   An unexpected finding of this study was the high incidence of recurrent variceal haemorrhage among those patients undergoing oesophageal transection and gastric devascularisation.

15.   In conclusion oesophageal transection and gastric devascularisation appears to confer no benefit over endoscopic sclerotherapy in terms of long term survival after variceal haemorrhage.

16.   Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed.

17.   TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or gastric varices and portal hypertensive gastropathy.

18.   Subsequent reports have shown TIPSS to be a safe and effective method for treating recurrent variceal haemorrhage and cases of encephalopathy after TIPSS are rare.

19.   Although transabdominal ultrasound showed flow through the shunt, the patient died from massive variceal haemorrhage before further assessment could be undertaken.