Transabdominal gastro-oesophageal devascularization and oesophageal transection for bleeding oesophageal varices

Abstract

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.

Transabdominal Gastro‐esophageal Devascularization and Esophageal Transection for Bleeding Esophageal Varices after Failed Injection Sclerotherapy: Long‐Term Follow‐Up Report

“…We reported our early results of TGDET for acutely bleeding esophageal varices 7. This report presents long‐term follow‐up on 142 consecutive patients who underwent the same procedure for failed sclerotherapy.…”

“…Various parameters recorded were: age, gender, nationality, clinical presentation, diagnosis, Child–Pugh score, initial management, outcome of surgery in terms of various intra‐ and postoperative complications, overall morbidity, and hospital mortality. The detailed methodology, definitions, operative procedure, and various operative difficulties have been described elsewhere 7. The cause of portal hypertension was determined by history, liver biopsy, and bilharzial and hepatitis serologies.…”

“…Transabdominal gastroesophageal devascularization and esophageal transection (TGDET) is the most favored emergency procedure for the control of continued bleeding after failed endoscopic therapy 2,4–6. We published our early results with this procedure in 1989 7. This study presents further evaluation of the procedure in patients with failed injection sclerotherapy.…”

Determination of Portal Shunt Index Using 123-Iodoamphetamine Transrectally

“…Liver cirrhosis with portal hypertension is one of the leading causes of death in Saudi Arabia [1] . There are different modalities of investigation and treatment, the method which denotes the best way of treatment, is yet to be discovered.…”

Resultados a longo prazo da desconexão ázigo-portal e esplenectomia em portadores de esquistossomose hepato-esplênica: avaliação clínica, laboratorial, endoscópica e ultra-sonográfica com tempo de seguimento mínimo de 5 anos

“…Intencionando diminuir a recidiva hemorrágica nos procedimentos de desconexão, alguns autores defendiam a associação de abordagem direta das varizes esofágicas, com suturas destas através da abertura do esôfago (Haddad et al, 1975;Kelner et al, 1982;Abrantes, 1986, Raia et al, 1994, gastrotomia (Degni, 1963;Chaib et al, 1983), ou através da transecção mecânica esofagiana (Bessa et al, 1988), procedimentos que são acompanhados do aumento no número de complicações como estenose esofágica e disfagia, e de óbitos por fístulas digestivas (Haddad et al, 1982;Bessa et al, 1988;al-Kraida et al, 1989). Com a finalidade de substituir estas técnicas e diminuir os índices de recidiva hemorrágica por restabelecimento da circulação colateral esofágica, idealizou-se a associação rotineira de escleroterapia endoscópica pós-operatória (Kelner et al, 1982;Leonardi et al, 1988;Boin, 1991;Pugliese, 1996).…”