title: Transthoraco-phrenic esophageal transection with paraesophago-gastric devascularization and splenectomy using a stapler.
abstract: OBJECTIVE
  Surgery remains the most reliable treatment for bleeding esophageal varices. The aim of this study was to introduce the operative technique of transthoraco-phrenic esophageal transection with paraesophagogastric devascularization using a stapler and to evaluate surgical results.
  
  
  METHODS
  Forty-five patients underwent the procedure; an elective procedure was performed in 22 patients (bleeders) and a prophylactic procedure in 23 patients (nonbleeders). Twenty-nine patients were classified as Child's A, 15 as B and 1 as C. Previous sclerotherapy had been performed in 5 patients.
  
  
  RESULTS
  No hospital deaths occurred. No patients developed postoperative anastomotic leakage, encephalopathy, or any complications related to phrenicotomy. Three patients bled postoperatively from recurrent esophageal varices. Cumulative 5-year bleeding rates were 5.0% in bleeders and 6.6% in non-bleeders. Two patients died due to bleeding varices. Cumulative 5-year survival rates were 72.1% and 78.8% in patients classified as Child's A and Child's B, respectively.
  
  
  CONCLUSIONS
  This procedure may be indicated for a majority of Child's A or B patients. Although the advantages of this procedure must be evaluated further, it may be an alternative when injection sclerotherapy and endoscopic ligation fail.
authors.affiliation: Department of Surgery, Niigata University School of Medicine.
authors.forename: K
authors.initials: K
authors.lastname: Tsukada
authors.forename: K
authors.initials: K
authors.lastname: Yoshida
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
authors.forename: T
authors.initials: T
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013156:Splenectomy / Q000379:methods*; D013270:Stomach / Q000098:blood supply; D013514:Surgical Procedures, Operative / Q000379:methods; D017792:Surgical Stapling / Q000379:methods*; D015996:Survival Rate