Gastric operations in patients with hepatic cirrhosis following endoscopic sclerotherapy.

Abstract

Three patients with hepatic cirrhosis who had undergone gastric operations following endoscopic sclerotherapy were retrospectively reviewed. One patient had undergone total gastrectomy for gastric cancer and two had Hassab and Tanner operations for gastric and esophageal varices. All patients were recovering with no complications related to the operations and were free of disease for 2 years, postoperatively.When esophageal varices are found in combination with an upper gastric cancer that requires total gastrectomy, endoscopic sclerotherapy for esophageal varices is contraindicated because severe esophageal injuries may be induced by the sclerosing agent. The Hassab and Tanner method is useful for esophageal and gastric varices after sclerotherapy. A repeat endoscopic sclerotherapy should be performed after this operation.

Zero Operative Mortality for Gastric Cancer with Hepatic Cirrhosis.

“…In this situation, preoperative sclerotherapy for varices is contraindicated because of esophageal damage caused by the sclerosing agents (Takeda et al 1989).…”

Recent role of splenectomy in chronic hepatic disorders

“… 5–7 were the first to report gastroesophageal devascularization and splenectomy for the treatment of esophageal varices, although it did not gain wide acceptance at that time because of the high recurrence rate. However, in light of the recent progress in endoscopic treatments for esophageal varices, EGDS after endoscopic treatments has undergone a resurged interest 60–62 . EGDS has three effeccts in treating varices; first is a decreased inflow by splenectomy, second is devascularization of the risky peri‐gastroesophageal collaterals, and the third is no huge portosystemic shunt formation 5–7 .…”

“…However, in light of the recent progress in endoscopic treatments for esophageal varices, EGDS after endoscopic treatments has undergone a resurged interest. [60][61][62] EGDS has three effeccts in treating varices; first is a decreased inflow by splenectomy, second is devascularization of the risky peri-gastroesophageal collaterals, and the third is no huge portosystemic shunt formation. [5][6][7] Hashizume et al 62 reported that recurrence rate after laparoscopic EGDS was 0% with blood loss of 500 mL during surgery.…”

Surgical Management of Gastric Cancer Patients with Liver Cirrhosis.

“…Postoperative care included water and sodium restriction, infusions of albumin and fresh-frozen plasma, diuretic and antibiotic therapy. (Takeda et al 1989).…”