Treatment of bleeding esophageal varices by transabdominal esophageal transection with the EEA stapling instrument.
Six cirrhotic patients underwent emergency esophageal transection utilizing the EEA Auto Suture stapling instrument for treatment of unrelenting variceal hemorrhage. All were grade C, and the combination of ascites, encephalopathy, and jaundice was present in four. All were critically ill with ancillary medical problems, including recent subtotal gastrectomy with sepsis and dehiscence, coexisting malignant biliary obstruction, and respiratory insufficiency. All were anergic to skin testing. Four died in the postoperative period, primarily of problems related to sepsis and ascites present before operation. Autopsy showed a well-healed anastomosis without stricture and complete interruption of the varices in all. No patient had recurrent bleeding. All received oral or tube feedings after operation. Two survive at 2 and 1.5 years with no recurrence of varices. This is a rapid, simple, and effective technique which can be done with minimal blood loss or training. There is no diversion of portal blood and minimal interruption of collateral circulation. Whereas the long-term benefits in terms of rebleeding are not yet known, results to date suggest a trial earlier and in better risk patients as a definitive treatment procedure.
D000368:Aged; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D018805:Sepsis / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013528:Surgical Staplers