Abstract
Abstract The management of the cirrhotic patient with bleeding gastro-oesophageal varices is discussed with particular reference to the role of emergency surgery. An analysis is made of the results obtained in 77 patients with emergency surgery to control recurrent haemorrhage. The deleterious effect of failing to control haemorrhage immediately and effectively in these cases is emphasized. If haemorrhage recurs in spite of conservative measures, including tamponade, surgery is considered mandatory. Only 8 cases have had an emergency portacaval anastomosis, with 4 survivors, all good-risk cases. More patients might benefit from this operation but only if haemorrhage is rapidly and effectively brought under control in the first instance. The poor-risk case has a 30 per cent chance of survival with a Boerema-Crile operation. However, this is not a definitive operation and patients who survive this procedure should have a portacaval anastomosis as soon as their liver function has sufficiently recovered.
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