title: Surgical management of gastric varices and morbid obesity: a novel approach.
abstract: BACKGROUND
  Morbid obesity is a growing pandemic. The greater prevalence of chronic conditions such as diabetes, hypertension, and heart and liver disease has made management of obesity challenging. Many surgical techniques are in practice, each with some elements of restrictive or malabsorptive components. Nonalcoholic steatohepatitis can lead to portal hypertension, which can further manifest as upper gastrointestinal bleeding.
  
  
  METHODS
  We performed sleeve gastrectomy at a nonuniversity tertiary care center, as a novel approach for the management of isolated gastric varices, in a morbidly obese cirrhotic patient.
  
  
  RESULTS
  The operating time was 142 minutes. The estimated blood loss was 150 mL. The patient did not receive intraoperative or postoperative transfusions. The length of stay was prolonged to 10 days because of an ischemic cardiac event that was managed by coronary angioplasty on postoperative day 7. The patient did not develop any other complications. During the next couple of months, the patient lost significant weight and had no complaints.
  
  
  CONCLUSIONS
  Sleeve gastrectomy with devascularization is a durable approach that will address the problems of both portal hypertension and morbid obesity, with the desired effect of weight reduction and treatment of gastric varices using a single surgical approach.
authors.affiliation: Methodist Dallas Medical Center, Dallas, Texas, USA.
authors.forename: Derick J
authors.initials: DJ
authors.lastname: Christian
authors.forename: Amit
authors.initials: A
authors.lastname: Khithani
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Castro-Arreola
authors.forename: David
authors.initials: D
authors.lastname: Levitan
authors.forename: D Rohan
authors.initials: DR
authors.lastname: Jeyarajah
mesh_terms: D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013162:Splenic Vein / Q000601:surgery*