Mortality and rebleeding after hypertensive variceal disconnections.
Forty-five patients had operative disconnections of portoazygos venous collaterals for variceal hemorrhage. Nineteen alcoholic patients had urgent partial azygos disconnection (PAD) to control bleeding; this involved intragastric variceal and coronary and distal gastric-vein ligation. A complete azygos disconnection (CAD), which also included splenectomy, was done urgently in 14 patients and electively in 12 patients; 15 were alcoholics. All patients were assessed for operative risk by a modified Child's classification. Hospital mortality after urgent PAD or CAD in alcoholics was 67%, largely due to intraperitoneal sepsis or hepatorenal failure with recurrent hemorrhage. Operative modified Child's classification of survivors was better (lower) than in nonsurvivors. Eleven nonalcoholic patients had CAD; two died of intraperitoneal sepsis. Nine survivors did not rebleed nor have encephalopathy develop during an average follow-up of 41 months. Complete azygos disconnection was a good alternative, particularly in the elective setting, for patients with nonalcoholic portal hypertension.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D012008:Recurrence