Treatment of Bleeding Esophageal Varices in Portal-Systemic Shunt Failures

Bernstein, Eugene F.; Varco, Richard L.; Wangensteen, Owen H.

doi:10.1001/archsurg.1969.01340140043007

Cited by 9 publications

(1 citation statement)

References 13 publications

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“…The alternative procedures like transthoracic ligation of oesophageal varices (14), oesophagogastrectomy with or without interposition of intestinalloop (3,12), proximal gastrectomy, oesophageal transection (13), mesocaval shunt (1,9), splenectomy either alone or in conjunction with other procedure, central splenorenal shunts are technically complicated and hazardous. Certain mortality is always there.…”

Section: Discussionmentioning

confidence: 99%

Selective Devascularisation of Stomach and Lienopulmopexy for Prevention of Bleedings in Portal Hypertension in Children

Sarkar¹,

Samanta²,

Dasgupta³

et al. 1988

Eur J Pediatr Surg

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Dissatisfied with different operative procedures for prevention of recurrent bleedings in childhood portal hypertension, many surgeons nowadays treat their patients conservatively during episodic attacks and advocate one of the shunt procedures in adolescence when the splenic vein becomes sufficiently widened (more than 1 cm). Even then mortality cannot be avoided in some bad risk patients especially those living in remote villages lacking facilities for blood transfusion and high speed transport service. In this situation thoracic transposition of spleen and lienopulmopexy was advocated by Nylander and Turumen, Auvert, M. Bettex and others. We prefer a further simpler procedure and perform selective devascularisation of stomach and lienopulmopexy. It allows rapid development of collaterals between splenic pulps on the portal side and subpleural venous plexus on the systemic side to achieve effective gastric devascularisation to prevent further bleeding without hindering the existing portal flow through the liver to avoid the possible occurrence of encephalopathy. Of 21 operated cases one died on the 5th postoperative day and the remaining 20 are doing well. 1/2-5 1/2 years' follow-up revealed negligible morbidity and no recurrence of bleeding in any of them. Both procedures work on the same principle.

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Section: Discussionmentioning

confidence: 99%

Selective Devascularisation of Stomach and Lienopulmopexy for Prevention of Bleedings in Portal Hypertension in Children

Sarkar¹,

Samanta²,

Dasgupta³

et al. 1988

Eur J Pediatr Surg

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The History of the Surgical Treatment of Portal Hypertension

Chandler

1993

Arch Surg

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Radical esophagogastrectomy for unshuntable extrahepatic portal hypertension with bleeding varices: Report of a case

Hirao

Kanehiro

et al. 1997

Surg Today

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A 29-year-old woman with idiopathic portal hypertension was referred to our department for the surgical management of repetitive bleeding from esophageal and gastric varices. At the age of 16 years she had undergone a splenectomy with esophageal transection followed by endoscopic sclerotherapy which had been performed a total of 24 times. Although vericeal hemorrhage was prevented for several months, bleeding from gastric varices and portal hypertensive gastropathy was not able to be controlled readily by endoscopic sclerotherapy from when she was 26 years old. On admission, angiographic studies showed a complete obstruction of the portal vein; however, a portosystemic shunt operation was not able to be performed due to her previous splenectomy. To control her repetitive bleeding, we decided to perform a total gastrectomy and distal esophagectomy with reconstruction by a Roux-en-Y esophagojejunostomy. Her postoperative course was uneventful, and no episodes of recurrent bleeding or other complications have developed, indicating that her quality of life has dramatically improved. Thus, we conclude that distal esophagectomy and total gastrectomy constitute an effective surgical treatment for unshuntable extrahepatic portal hypertension.

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Treatment of Bleeding Esophageal Varices in Portal-Systemic Shunt Failures

Cited by 9 publications

References 13 publications

Selective Devascularisation of Stomach and Lienopulmopexy for Prevention of Bleedings in Portal Hypertension in Children

Selective Devascularisation of Stomach and Lienopulmopexy for Prevention of Bleedings in Portal Hypertension in Children

The History of the Surgical Treatment of Portal Hypertension

Radical esophagogastrectomy for unshuntable extrahepatic portal hypertension with bleeding varices: Report of a case

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