Safety and Effect of the Perigastric Devascularization with Transection of Esophagus for Treatment of Esophageal Varices

ABSTRACT

PURPOSE: There are a variety of approaches to the treatment of esophageal varix. This study evaluates the value of perigastric devascularization with transection of the esophagus, a non-shunt operation, for the management of bleeding esophageal varices. METHODS: We retrospectively analyzed the medical records of 16 patients with esophageal varix bleeding who had undergone perigastric devascularization with transection of the esophagus from 1990 through 2000. RESULTS: The mean age of the patients was 40.8 years and the most common underlying pathology was viral hepatitis. All patients had a history of previous variceal bleeding. Elective and prophylactic surgery was done in 8 and 5 patients respectively, and emergency surgery in 3 patients. One patient in Child group C and underwent emergency surgery, died after operation (mortality rate 6.3%). In the remaining 15 patients, two patients died of hepatocellular carcinoma. None of the patients demonstrated rebleeding or recurrence of the varix in the follow-up period. In 8 patients, the liver function, as measured by Child-Pugh classification, was improved following surgery as compared with measurements at the time of admission. CONCLUSION: According to this study, in spite of the small number of patients, we suggest that perigastric devascularization with transection of the esophagus is a very safe and effective treatment modality for esophageal varix bleeding, particularly if it can be done for an elective or prophylactic purpose. Furthermore, we propose that the operation should be carried out in an elective rather than in emergency manner following the improvement of liver function by non- invasive medical treatment.