Transthoracic, transgastric interruption of bleeding esophageal varices.

Abstract

Portasystemic shunt operations provide effective and prolonged control of bleeding from gastroesophageal varices accompanying portal hypertension. In patients who are not candidates for emergency portal decompression because of extrahepatic portal vein obstruction, small size of vein, or other reasons, direct surgical interruption of bleeding esophageal varices may be employed. Transesophageal suture of varices, as advocated by Boerema, 1 Crile, 2 and Linton and Warren 3 controls bleeding immediately but is followed by a high incidence of rebleeding and the risk of leakage from an esophageal suture line. More extensive operations such as gastroesophageal resection 4,5 gastric or esophageal transection, 6 and portaazygos disconnection, 7 reduce the likelihood of recurrent bleeding but require an esophageal anastomosis and may cause gastroesophageal reflux and esophagitis postoperatively. To reduce these hazards, a technique has been devised for transthoracic, transgastric suture of bleeding varices with devascularization and reconstruction of the cardia. This method interrupts submucosal