Effect of delayed operation for bleeding esophageal varices on Child's class and indices of liver function.
The charts of 38 patients managed with a period of intensive medical treatment (mean 7 days) prior to portosystemic shunting were examined. We found that the operative delay did not improve the Child's class or the indices of liver function. The operative mortality rates in these patients were 0 in Child's A patients, 13 percent in Child's B patients, and 50 percent in Child's C patients. Based on these findings, we began to operate on patients with bleeding esophageal varices as soon as they stabilized. The charts of 10 consecutive Child's C patients operated on without a period of intensive medical management (mean 3 days) were reviewed and compared with the charts of 8 Child's C patients with delayed operation. The two groups of patients were similar. We recommend that patients who need a shunt should be operated on as soon as possible after bleeding has ceased.
Grossman
M D
MD
Department of Surgery, University of Utah, Salt Lake City 84132.
McGreevy
J M
JM
D001663:Bilirubin / Q000097:blood; D001803:Blood Transfusion; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D011170:Portasystemic Shunt, Surgical; D011517:Prothrombin Time; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors
D012709:Serum Albumin; D001663:Bilirubin