Control of the Hyperdynamic Circulation in Patients with Bleeding Esophageal Varices

Johnson, George; Womach, N A; Gabriele, Orlando F.; Peters, Richard M.

doi:10.1097/00000658-196905000-00003

Cited by 23 publications

(5 citation statements)

References 14 publications

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“…All causes of recurrent bleeding in our series were lumped together because it was often difficult to decide which lesion was to blame, and bleeding from any source in portal hypertension should be considered a failure of therapy [26]. Our incidence of recurrent hemorrhage (43.6%) was as high as that of the original Womack devascularization procedure [27] but with much improved mortality rates. Episodes of recurrent bleeding in our series incurred a 13% mortality rate and was generally controlled with vasopressin, sclerotherapy, or repeat embolization.…”

Section: Discussionmentioning

confidence: 80%

Splenic artery and coronary vein occlusion for bleeding esophageal varices

et al. 1984

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Fifty consecutive, unselected, endoscopicaily confirmed patients with bleeding esophageal varices received splenic artery and coronary vein occlusion as their primary treatment. This was accomplished surgically in the first 30 patients and by interventional angiography in the last 20. The in-hospital mortality rate was 22% and the actuarial 5year survival rate was 52%. The incidence of recurrent gastrointestinal bleeding from all causes was 43.6% with a mortality rate of 13%.The mean decrease in portal pressure was 8.5 cm H20, and subsequent angiograms in 14 survivors revealed significant increases in the diameter of the proper hepatic artery, and decreases in the diameter of the portal vein. Hepatic function improved in 10 of the 32 Child's class B cirrhotics. The increase in the blood platelets of the survivors was statistically significant when compared with the decline in those who died.The long-term results of splenic artery and coronary vein occlusion, performed surgically or angiographically, compare favorably with other methods used to control bleeding esophageal varices.

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Section: Discussionmentioning

confidence: 80%

Splenic artery and coronary vein occlusion for bleeding esophageal varices

et al. 1984

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“…We believe that the most expeditious, safe, and effective procedure is the 2-stage esophageal transection with paraesophagogastric devascularization. There are many nonshunting procedures, such as transesophageal or transgastric interruption of the continuity of varices by direct suture, partial or total esophagectomy, and proximal hemigastrectomy by either the transthoracic or the transabdominal approach [4][5][6][7][8][9][10][11]. Two major objections have been raised to nonshunting procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The major difference between our operation and other ablative or extirpative nonshunting procedures, such as those of Womach and Johnson [11], Tanner [6], Britton [9], Habif [7] esophagus and the proximal stomach with our technique is much more complete than in the others. We believe that it is imperative to obtain complete devascularization of the lower half of the esophagus and proximal stomach, from the level of the inferior pulmonary vein to just proximal to the incisura angularis of the stomach for a good long-term result.…”

Section: Discussionmentioning

confidence: 99%

Emergency esophageal transection with paraesophagogastric devascularization for variceal bleeding

et al. 1979

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Since 1967, a total of 52 patients with portal hypertension have undergone emergency esophageal transection with paraesophagogastric devascularization in 2 stages, 4–6 weeks apart, to control variceal bleeding. According to the Child classification, 8 patients were class A, 19 were class B, and 25 were class C. The etiology of the portal hypertension was cirrhosis of the liver in 30 patients, liver fibrosis in 13, extrahepatic portal vein occlusion in 4, hepatoma in 4, and carcinoma of the pancreas in 1 patient. There were 6 operative deaths (11.5%), caused by progressive hepatic failure (2), hepatoma (2), renal failure (1), and intraperitoneal bleeding (1). The operative mortality rate in the class A and B patients was 0%, but in the class C patients, it was 24%. The operative mortality rate for cirrhotic patients was 10%. There have been 9 late deaths due to hepatic failure (2), hepatoma (4), esophageal variceal bleeding (2), and carcinoma of the pancreas (1). At present, 88% of class B patients are alive, but only 56% of class C patients are alive. There was an obvious positive correlation between survival rate and the stage of the disease. Only 2 patients with incomplete devascularization developed recurrent esophageal variceal bleeding and died (recurrence rate of 4.3%). All survivors are free of hepatic encephalopathy. This method provided excellent results in controlling variceal bleeding without causing hepatic dysfunction and encephalopathy and is indicated in all patients with variceal bleeding except those with severe hepatic failure.

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“…The concept of using this kind of hemodynamic information for preoperative assessment can be traced back through the literature for several decades, particularly in the publications of Womack and his associates, 209,210 but its general acceptance came from the brilliant studies of Warren, Zeppa, and Fomon, 211 published in 1967. The Warren-Zeppa-Fomon article was the first step toward the increasingly accepted objective 212 of decompressing esophagogastric varices without paying the penalty of hepatic portal flow deprivation.…”

Section: Portal Flow Studies In Shunt Planningmentioning

confidence: 99%

The ECK fistula in animals and humans

Starzl¹

1983

Current Problems in Surgery

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Control of the Hyperdynamic Circulation in Patients with Bleeding Esophageal Varices

Cited by 23 publications

References 14 publications

Splenic artery and coronary vein occlusion for bleeding esophageal varices

Splenic artery and coronary vein occlusion for bleeding esophageal varices

Emergency esophageal transection with paraesophagogastric devascularization for variceal bleeding

The ECK fistula in animals and humans

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