title: Laparoendoscopic transgastric histoacryl injection of gastric varices: a new surgical approach.
abstract: BACKGROUND
  Gastric varices (GVs) are a common finding in Egyptian patients with portal hypertension due to cirrhosis or schistosomal hepatic fibrosis. These patients present with an acute attack or history of hematemesis. Endoscopic histoacryl injection is the standard treatment in Egypt; however, because of technical difficulties it is possible to inject only a little amount of this material, as it may endanger the channels of the flexible endoscope. We thought of a new surgical laparoendoscopic technique to obviate the need for repeated endoscopies and complete obliteration of GVs.
  
  
  METHODS
  This study was conducted on 20 patients with portal hypertension and GVs. After the patient was placed under general anesthesia, a small gastrostomy was done in the anterior gastric wall through which a 10-mm trocar was inserted for the laparoscopic camera. Injection of GVs was done via a spinal needle or a central venous line needle inserted directly. Injection of an adequate amount of histoacryl was done under direct vision.
  
  
  RESULTS
  This study was conducted from July 2009 to August 2011 on 20 patients with GVs. The age range was from 22 to 56 years, with a mean age of 39.8±7.85 years. There were 14 men (70%) and 6 women (30%). Fourteen patients (70%) showed complete obliteration of GVs after one session of treatment, whereas 6 patients (30%) had unsatisfactory results and were subjected to another session. GVs were completely obliterated after the second session in 4 patients. Two cases of recurrence of GVs were operated on.
  
  
  CONCLUSIONS
  This new technique enabled us to inject GVs with a suitable amount of glue material under direct vision without harming the endoscope. Use of this procedure is recommended in patients fit for surgery and those who had failed endoscopic injection sclerotherapy.
authors.affiliation: Gastrointestinal Surgical Unit, General Surgery Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. dr_m_kassem@yahoo.com
authors.forename: Mohamed I
authors.initials: MI
authors.lastname: Kassem
authors.forename: Hani M
authors.initials: HM
authors.lastname: El-Haddad
authors.forename: Hassan A
authors.initials: HA
authors.lastname: El-Bahrawi
mesh_terms: D000328:Adult; D004659:Enbucrilate / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D004659:Enbucrilate