[The value collateralization and venous obstruction operations in acute bleeding esophageal varices in patients with cirrhosis of the liver]

Abstract

Despite the development of new techniques and the great successes in recent years in Japan, the value of surgical venous obstruction in the treatment of oesophageal and gastric variceal bleeding remains controversial. For this reason we chose to evaluate our own results over a period of 10 years. Splenectomy is the only curative operation that eliminates the local portal hypertension in peripheral thrombosis of the splenic vein. Transposition of the spleen to the thoracic cavity with establishment of splenopulmonary anastomoses is indicated in the case of prehepatic block in childhood. The most widespread and successful of the operations to achieve venous obstruction are extended oesophagogastric disconnection (devascularisation with selective proximal vagotomy and fundoplication) as introduced by our group; para-oesophagogastric devascularisation and oesophageal transection according to Johnston using the clip suture device; and devascularisation of the upper two-thirds of the stomach and half of the abdominal oesophagus with transection, splenectomy and pyloroplasty after Sugiura and Futagawa. In the 10-year period analysed, we operated on 90 patients with acute bleeding oesophageal varices, many of them as emergencies. 66% were classified as Child-Pugh type C. Early mortality amounted to 26% (n = 24), and the morbidity rate was 42%. The 5- and 10-year survival rates were 50% and 38% respectively with regular endoscopic follow-up and repeat sclerotherapy. In an emergency, the choice between a shunt operation and a venous obstruction procedure depends on the individual case and the surgeon's experience.(ABSTRACT TRUNCATED AT 250 WORDS)