Left-upper-quadrant devascularization for 'unshuntable' portal hypertension.

Abstract

No simple solution exists for the patient with bleeding due to diffuse splanchnic venous thrombosis (so-called unshuntable portal hypertension). Radical gastroesophageal devascularization or extended esophagogastrectomy has been considered obligatory in this setting. To examine the use of 1-stage, left-upper-quadrant devascularization for unshuntable portal hypertension. A retrospective call-back survey. A regional referral center. Eight consecutive patients with recurrent bleeding from esophagogastric varices due to diffuse splanchnic venous thrombosis. Splenectomy, staple transection of the esophagus, and proximal gastric devascularization. Operative complications, recurrent bleeding, survival, and quality of life. No operative deaths occurred, and 7 of 8 patients who were treated for unshuntable portal hypertension and who were followed-up for 1 to 15 years (mean, 4.7 years) are alive. No patient has had a recurrent variceal hemorrhage. A second endoscopy has demonstrated small varices in 4 patients. Early and late complications occurred in 3 and 1 of the patients, respectively. Left-upper-quadrant devascularization is a technically straightforward, safe, effective, and durable alternative to the Sugiura procedure or to radical esophagogastrectomy in patients with unshuntable portal hypertension.