THE SURGICAL TREATMENT OF ASCITES DUE TO CIRRHOSIS OF THE LIVER.

It is taught generally that ascites in cirrhosis of the liver is due to mechanical obstruction of the portal circulation. Where the portal congestion is relieved through existing collateral channels, ascites may be absent. Cases of cirrhosis with ascites have been recorded in which the formation of more or less extensive peritoneal adhesions, due to repeated tappings or other causes, has been followed by recovery from ascitic accumulations. Ascites in cirrhosis of the liver may be regarded, then, as an indication that sufficient collateral circulation can not be established spontaneously, most likely on account of absence of some of the natural but inconstant communications between the portal system and the general venous system. Packard and LeConte¹ discuss the surgical treatment for the relief of the ascites of cirrhosis, brought to the attention of physicians by Talma, and first carried to a successful issue by Drummond and Morison. The various