TRANSABDOMINAL EXTENSIVE ESOPHAGOGASTRIC DEVASCULARIZATION WITH GASTROESOPHAGEAL STAPLING IN THE MANAGEMENT OF ACUTE VARICEAL BLEEDING

Background Operation is required for patients with portal hypertension who have failed to respond to emergency sclerotherapy for control of acute variceal bleeding. This study evaluates the role of transabdomin al extensive oesophagogastric devascularization combined with gastro-o esophageal stapling for control of acute variceal bleeding in patients with portal hypertension of different aetiologies. Methods Transabdom inal extensive oesophagogastric devascularization combined with gastro oesophageal stapling was performed in 65 patients (28 with cirrhosis, 17 with non-cirrhotic portal fibrosis and 20 with extrahepatic portal venous obstruction) in whom emergency endoscopic sclerotherapy, and/or pharmacotherapy and balloon tamponade had failed. The Sugiura procedu re was modified to minimize operating time and to reduce the operative difficulties due to oesophageal wall necrosis after sclerotherapy. Re sults The operative mortality rate was higher in patients with cirrhos is (P = 0.0003); sepsis was the leading cause of death (in nine of 18) . A high mortality rate (12 of 15) was seen in patients with Child gra de C cirrhosis. Control of bleeding was achieved in all patients. The procedure-related complication rate was 17 per cent with a 6 per cent oesophageal leak rate; four of 47 surviving patients developed oesopha geal stricture. During a mean follow-up of 33 months, residual varices , recurrent varices and rebleeding were seen in three, two and three o f 47 survivors. Conclusion Transabdominal extensive oesophagogastric d evascularization combined with gastrooesophageal stapling is an effect ive and safe procedure for control of acute variceal haemorrhage with satisfactory long-term control, especially in patients without cirrhos is and low-risk patients with cirrhosis.