Background. During the past 18 years we have used a selective operativ
e approach for variceal bleeders in whom endoscopic sclerotherapy fail
ed or sclerotherapy was not indicated. Esophagogastric devascularizati
on with splenectomy has been reserved for unshuntable patients and for
those in whom a shunt was deemed inadvisable The purposes of this stu
dy are to describe the surgical procedure technique and indications fo
r esophagogastric devascularization and to report its long-term result
s. Methods. Thirty-two patients who underwent either a limited (n = 9)
or extensive (n = 23) esophagogastric devascularization procedure wit
hout esophageal transection for variceal bleeding were retrospectively
reviewed. Common indications were thrombosis of all splanchnic veins
(n = 12), distal splenorenal shunt thrombosis (n = 7), generalized por
tal hypertension with isolated splenic vein thrombosis (n = 5), and sy
mptomatic splenomegaly or severe hypersplenism (n = 6). Eighteen patie
nts (56%) had cirrhosis, eleven (34%) received an emergency operation,
and eighteen (56%) bled from gastric varices. Results. Three patients
with Child's class C disease undergoing emergency surgery died during
the early postoperative interval. Rebleeding occurred in nine survivi
ng patients (31%) and was the cause of death in three. Rebleeding rate
s for the limited and extensive devascularization procedures were 50%
and 24%, respectively. Only one of 11 patients with diffuse splanchnic
venous thrombosis without liver disease has died. The 5-year survival
rate of patients with liver disease was 51%. Only two patients experi
enced postoperative encephalopathy. Conclusions. When used in selected
patients, esophagogastric devascularization without esophageal transe
ction is a reasonably effective alternative to shunt surgery.