[Results of devascularization surgery of the gastroesophageal junction in recurrent hemorrhage of esophageal and fundus varices].
Bleeding esophageal and gastric varices caused by portal hypertension with (group I) or without (group II) liver damage should be treated primarily by sclerotherapy or shunt-operation if there is no indication for liver transplantation. In the case of rebleeding associated with thrombosis of portal-/mesenteric or splenic vein we performed in 17 patients a complete devascularisation of the proximal stomach, cardia and distal esophagus (Hassab's operation 1967) (N = 5--group I; N = 12--group II). In group I, the early postoperative (0-30 days p.o.) course was complicated by one necrosis of the gastric fundus. In group II, postoperative bleeding from gastric varices was noted in four patients, three of which were treated by proximal gastric resection; two of twelve patients died. No serious complications in the long-term follow-up (min. 171--max. 1217 days) occurred in group I. In group II, half of the patients died (1 bleeding episode, 1 liver coma, 1 hepatocellular carcinoma, 2 other causes). The operative risk and the long-term prognosis are essentially influenced by the basic disease and to a much lesser degree by the type of operation. The devascularisation of the esophago-gastric junction is per se a low risk intervention which is always practicable, even in high risk patients.
Riemenschneider
T
T
Klinik und Poliklinik für Chirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn.
Bermel
R E
RE
Hirner
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery; D002423:Cause of Death; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D004943:Esophagogastric Junction / Q000098:blood supply*; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012008:Recurrence; D015996:Survival Rate; D014680:Veins / Q000601:surgery
Ergebnisse der Devaskularisationsoperation des gastroösophagealen Uberganges bei Rezidivblutungen aus Osophagus- und Fundusvarizen.