Emergency esophageal transection with paraesophagogastric devascularization for variceal bleeding

Abstract

AbstractSince 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.