Transabdominal extensive oesophagogastric devascularization with gastro-oesophageal stapling in the management of acute variceal bleeding

Autor:	S. S. Karandikar, Arif Dalvi, Mathur Sk, Z. F. Soonawala, Sudeep R. Shah, D. F. Mirza, S. S. Nagral
Rok vydání:	1997
Předmět:	medicine.medical_specialty Varix Cirrhosis business.industry Balloon tamponade medicine.medical_treatment medicine.disease Sugiura procedure Surgery medicine.anatomical_structure medicine Sclerotherapy Portal hypertension Esophagus business Varices
Zdroj:	British Journal of Surgery. 84:413-417
ISSN:	0007-1323
DOI:	10.1046/j.1365-2168.1997.02522.x
Popis:	Background Operation is required for patients with portal hypertension who have failed to respond to emergency sclerotherapy for control of acute variccal bleeding. This study evaluates the role of transabdominal extensive oesophagogastric devascularization combined with gastro-oesophageal stapling for control of acute variceal bleeding in patients with portal hypertension of different aetiologies. Methods Transabdominal extensive oesophagogastric devascularization combined with gastro-oesophageal stapling was performed in 65 patients (28 with cirrhosis, 17 with non-cirrhotic portal fibrosis and 20 with extrahepatic portal venous obstruction) in whom emergency endoscopic sclerothcrapy, and/or pharmacotherapy and balloon tamponade had failed. The Sugiura procedure was modified to minimize operating time and to reduce the operative difficulties due to oesophageal wall necrosis after sclerotherapy. Results The operative mortality rate was higher in patients with cirrhosis (P = 0·0003); sepsis was the leading cause of death (in nine of 18). A high mortality rate (12 of 15) was seen in patients with Child grade C cirrhosis. Control of bleeding was achieved in all patients. The procedure-related complication rate was 17 per cent with a 6 per cent oesophageal leak rate; four of 47 surviving patients developed oesophageal stricture. During a mean follow-up of 33 months, residual varices, recurrent variccs and rebleeding were seen in three, two and three of 47 survivors. Conclusion Transabdominal extensive oesophagogastric devascularization combined with gastro-oesophageal stapling is an effective and safe procedure for control of acute variceal haemorrhage with satisfactory long-term control, especially in patients without cirrhosis and low-risk patients with cirrhosis.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::a7f87386b6ed8da06d0b1166d3f772b6 https://doi.org/10.1046/j.1365-2168.1997.02522.x Zobrazit plný text záznamu Plný text