Selective periesophagogastric devascularization in portal hypertension: results of 56 patients.
OBJECTIVE
Surgery remains the most reliable treatment for bleeding esophageal varices. We propose a new modified procedure as selective periesophogastric devascularization (SPD), in which paracardial spontenous collaterals were preserved and only pericardial collaterals and perforating branches were disconnected. This study aimed to evaluate the results of SPD in variceal bleeding.


METHODS
The results of 56 patients subjected to SPD for bleeding esophageal varices, were retrospectively reviewed. Etiology of portal hypertension was chronic HBV cirrhosis in 80.4% (45/56), alcoholic in 12.5% (7/56) and others 7.1% (4/56). Child-Pugh grading on admission was A: 78.6% (44/56), B: 14.3% (8/56), and C: 7.1% (4/56). Evaluation was made in terms of effectiveness in controlling the acute bleeding, postoperative morbidity and mortality, recurrent bleeding, encephalopathy and 3-year survival rate.


RESULTS
Hemorrhage was controlled in all cases with no death rate. Portal vein thrombosis in 3.6% (2/56), and pleurorrhea in 8.9% (5/56) of cases. In-hospital morbidity was 12.5% (7/56). Complete eradication of varices was observed in 87.5% (49/56) patients. Recurrent variceal bleeding was noticed in 8.9% (5/56) of cases. No patient developed encephalopathy until one month postoperatively. 42 patients were followed up postoperatively for three years. The 3-year survival for patients with Child-Pugh A was 100% (32/32), B was 71.4% (5/7), and 33%(1/3) for C.


CONCLUSIONS
SPD was safe and effective in control of bleeding varices in portal hypertension.
Shi
Baomin
B
Department of General Surgery, Shandong Provincial Hospital, Shandong University, 324 Jingwu Road Jinan 25002, China. baomins@tom.com
Yang
Zhen
Z
Wang
Xiuyan
X
Xu
Jian
J
Lu
Xiaofei
X
Liang
Feng
F
Mu
Qingling
Q
Wu
Tai-Huang
TH
D000328:Adult; D000368:Aged; D003097:Collateral Circulation; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome