Transabdominal suture of bleeding gastro-oesophageal varices in cryptogenic cirrhosis of the liver

Abstract

Emergency transabdominal suture of gastro-oesophageal varices was performed when conventional conservative measures including oesophageal tamponade failed to control bleeding in 60 of 167 patients with cryptogenic cirrhosis and bleeding varices. The immediate mortality for the whole series was 29-9 per cent. Surgery performed in this selected manner carried an immediate mortality of 40 per cent. The transabdominal approach detected and treated 19 (31-7 per cent) patients who had concomitant bleeding from extra-oesophageal sources. Ageing and sex (male) affect the immediate prognosis adversely. Using a modification of Child's classification of hepatic dysfunction, a direct relationship between hepatic dysfunction and mortality was found, reaching 100 per cent in those with grade C (severe) dysfunction, irrespective of whether or not surgery had been performed. Bleeding was successfully arrested in 96-7 per cent of cases and recurrence of bleeding was acceptably low in the first 6 months of surgery but not after.