Fifty consecutive unselected patients presenting with acute haematemesis and melaena from endoscopically confirmed bleeding oesophageal varices were treated by one-stage transabdominal oesophageal transection with gastro-oesophageal devascularization and splenectomy. According to Child's classification, 15 were Grade A, 29 Grade B and six Grade C. The mortality rate was 10 per cent. Postoperative complications included gastric fundal leak (4 per cent), pleural effusion (4 per cent), subphrenic abscess (2 per cent), atelectasis (2 per cent) and pneumothorax (2 per cent). Although five patients (10 per cent) complained of transient dysphagia during follow-up, only one (2 per cent) presented evidence of stricture at the site of oesophageal transection. Clinical encephalopathy was not present in the surviving patients in the postoperative period. No recurrence of bleeding has been recorded in the surviving patients over a follow-up period of 2-3 years.

No abstract

TGDET remains a safe and effective procedure after failure of sclerotherapy when other alternatives are either not indicated or not available.

Sixty-eight patients with hydatid disease involving various organs were admitted to Riyadh Central Hospital during a two-year period. The liver was involved in 42 patients, and 33 of them were treated surgically. Casoni's intradermal test (87% positive) and ultrasonography were the two most helpful investigations for establishing the diagnosis. Computerized tomography helped in better localization of the cyst and planning a suitable surgical procedure. Total cystoperiocystectomy was carried out on five patients, and three patients were treated by endocystectomy with omentoplasty. No complications were noted among these patients. Endocystectomy with tube drainage was performed on 23 patients. This procedure was found most suitable for the majority of patients. Complications can be minimized by careful attention to any biliary communications and earlier removal of the drainage tube. There was no mortality following surgery in this series, but one patient died of anaphylaxis following percutaneous transhepatic cholangiography. Twenty percent hypertonic saline was used as a scolecidal agent in this series, and mild hypernatremia was noted among some patients. Serum sodium monitoring is recommended during the immediate postoperative period.A Al-Kraida, MK Alam, SQ, QO Al-Qasabi, AM Bashier, Hydatid Disease of The Liver in Riyadh. 1988; 8(2): 117-121 MeSH