TRANSABDOMINAL ESOPHAGOGASTRIC DEVASCULARIZATION AS TREATMENT FOR VARICEAL HEMORRHAGE

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.