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Transthoracic, Transgastric Interruption of Bleeding Esophageal Varices

Transthoracic, Transgastric Interruption of Bleeding Esophageal Varices Abstract Portasystemic shunt operations provide effective and prolonged control of bleeding from gastroesophageal varices accompanying portal hypertension. In patients who are not candidates for emergency portal decompression because of extrahepatic portal vein obstruction, small size of vein, or other reasons, direct surgical interruption of bleeding esophageal varices may be employed. Transesophageal suture of varices, as advocated by Boerema,1 Crile,2 and Linton and Warren3 controls bleeding immediately but is followed by a high incidence of rebleeding and the risk of leakage from an esophageal suture line. More extensive operations such as gastroesophageal resection4,5 gastric or esophageal transection,6 and portaazygos disconnection,7 reduce the likelihood of recurrent bleeding but require an esophageal anastomosis and may cause gastroesophageal reflux and esophagitis postoperatively. To reduce these hazards, a technique has been devised for transthoracic, transgastric suture of bleeding varices with devascularization and reconstruction of the cardia. This method interrupts submucosal References 1. Boerema, I.: Bleeding Varices of the Esophagus in Cirrhosis of the Liver and Bonti's Syndrome , Arch Chir Neerl 1:253 ( (autumn) ) 1949. 2. Crile, G., Jr.: Transesophageal Ligation of Bleeding Esophageal Varices , Arch Surg 61:654-660 ( (Oct) ) 1950.Crossref 3. Linton, R.R., and Warren, R.: The Emergency Treatment of Massive Bleeding From Esophageal Varices by Transesophageal Suture of Those Vessels at the Time of Acute Hemorrhage , Surgery 33:243-244 ( (Feb) ) 1953. 4. Cooley, D.A., and DeBakey, M.E.: Subtotal Esophagectomy for Bleeding Esophageal Varices , Arch Surg 68:854-871 ( (June) ) 1954.Crossref 5. Phemister, D.B., and Humphreys, E.M.: Gastroesophageal Resection and Total Gastrectomy in the Treatment of Bleeding Varicose Veins in Banti's Syndrome , Ann Surg 126:397-410 ( (Oct) ) 1947.Crossref 6. Walker, R.M.: Esophageal Transection for Bleeding Varices , Surg Gynec Obstet 118:323-329 ( (Feb) ) 1964. 7. Tanner, N.C.: Direct Operations in the Treatment of Complications of Portal Hypertension , J Int Coll Surg 36:308-314 ( (Sept) ) 1961. 8. Skinner, D.B., and Camp, T.F., Jr.: Relation of Esophageal Reflux to Lower Esophageal Sphincter Pressures Decreased by Atropine , Gastroenterology 54:543-551 ( (April) ) 1968. 9. Skinner, D.B., and Belsey, R.H.R.: Surgical Management of Esophageal Reflux and Hiatus Hernia , J Thorac Cardiovasc Surg 53:33-54 ( (Jan) ) 1967. 10. Child, C.G., III, and Turcotte, J.G.: "Surgery and Portal Hypertension," in Childs, C.G., III (ed.): The Liver and Portal Hypertension , Philadelphia: W. B. Saunders Co., 1964. 11. Liebowitz, H.R.: Pathogenesis of Esophageal Varix Rupture , JAMA 175:874-870 ( (March) ) 1961.Crossref 12. Orloff, M.J., and Thomas, H.S.: Pathogenesis of Esophageal Varix Rupture , Arch Surg 87:301-307 ( (Aug) ) 1963.Crossref 13. Wagenknecht, T.W.; Nobel, T.F.; and Baronofsky, I.D.: Nature of Bleeding Esophageal Varices , Surgery 33:869-874 ( (June) ) 1953. 14. Cohn, R., and Mathewson, C., Jr.: Observations of Patients During the Surgical Treatment of Acute Massive Hemorrhage From Esophageal Varices Secondary to Cirrhosis of the Liver , Surgery 41:94-101 ( (Jan) ) 1957. 15. Ludington, L.G.: A Study of 158 Cases of Esophageal Varices , Surg Gynec Obstet 106:519-526 ( (May) ) 1958. 16. Orloff, M.J.: A Comparative Study of Emergency Transesophageal Ligation and Non-surgical Treatment of Bleeding Esophageal Varices in Unselected Patients With Cirrhosis , Surgery 52:103-116 ( (July) ) 1962. 17. Johnson, G., Jr., et al: Hemodynamic Changes With Cirrhosis of the Liver , Ann Surg 163:692-703 ( (May) ) 1966.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Transthoracic, Transgastric Interruption of Bleeding Esophageal Varices

Archives of Surgery , Volume 99 (4) – Oct 1, 1969

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Publisher
American Medical Association
Copyright
Copyright © 1969 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1969.01340160027006
Publisher site
See Article on Publisher Site

Abstract

Abstract Portasystemic shunt operations provide effective and prolonged control of bleeding from gastroesophageal varices accompanying portal hypertension. In patients who are not candidates for emergency portal decompression because of extrahepatic portal vein obstruction, small size of vein, or other reasons, direct surgical interruption of bleeding esophageal varices may be employed. Transesophageal suture of varices, as advocated by Boerema,1 Crile,2 and Linton and Warren3 controls bleeding immediately but is followed by a high incidence of rebleeding and the risk of leakage from an esophageal suture line. More extensive operations such as gastroesophageal resection4,5 gastric or esophageal transection,6 and portaazygos disconnection,7 reduce the likelihood of recurrent bleeding but require an esophageal anastomosis and may cause gastroesophageal reflux and esophagitis postoperatively. To reduce these hazards, a technique has been devised for transthoracic, transgastric suture of bleeding varices with devascularization and reconstruction of the cardia. This method interrupts submucosal References 1. Boerema, I.: Bleeding Varices of the Esophagus in Cirrhosis of the Liver and Bonti's Syndrome , Arch Chir Neerl 1:253 ( (autumn) ) 1949. 2. Crile, G., Jr.: Transesophageal Ligation of Bleeding Esophageal Varices , Arch Surg 61:654-660 ( (Oct) ) 1950.Crossref 3. Linton, R.R., and Warren, R.: The Emergency Treatment of Massive Bleeding From Esophageal Varices by Transesophageal Suture of Those Vessels at the Time of Acute Hemorrhage , Surgery 33:243-244 ( (Feb) ) 1953. 4. Cooley, D.A., and DeBakey, M.E.: Subtotal Esophagectomy for Bleeding Esophageal Varices , Arch Surg 68:854-871 ( (June) ) 1954.Crossref 5. Phemister, D.B., and Humphreys, E.M.: Gastroesophageal Resection and Total Gastrectomy in the Treatment of Bleeding Varicose Veins in Banti's Syndrome , Ann Surg 126:397-410 ( (Oct) ) 1947.Crossref 6. Walker, R.M.: Esophageal Transection for Bleeding Varices , Surg Gynec Obstet 118:323-329 ( (Feb) ) 1964. 7. Tanner, N.C.: Direct Operations in the Treatment of Complications of Portal Hypertension , J Int Coll Surg 36:308-314 ( (Sept) ) 1961. 8. Skinner, D.B., and Camp, T.F., Jr.: Relation of Esophageal Reflux to Lower Esophageal Sphincter Pressures Decreased by Atropine , Gastroenterology 54:543-551 ( (April) ) 1968. 9. Skinner, D.B., and Belsey, R.H.R.: Surgical Management of Esophageal Reflux and Hiatus Hernia , J Thorac Cardiovasc Surg 53:33-54 ( (Jan) ) 1967. 10. Child, C.G., III, and Turcotte, J.G.: "Surgery and Portal Hypertension," in Childs, C.G., III (ed.): The Liver and Portal Hypertension , Philadelphia: W. B. Saunders Co., 1964. 11. Liebowitz, H.R.: Pathogenesis of Esophageal Varix Rupture , JAMA 175:874-870 ( (March) ) 1961.Crossref 12. Orloff, M.J., and Thomas, H.S.: Pathogenesis of Esophageal Varix Rupture , Arch Surg 87:301-307 ( (Aug) ) 1963.Crossref 13. Wagenknecht, T.W.; Nobel, T.F.; and Baronofsky, I.D.: Nature of Bleeding Esophageal Varices , Surgery 33:869-874 ( (June) ) 1953. 14. Cohn, R., and Mathewson, C., Jr.: Observations of Patients During the Surgical Treatment of Acute Massive Hemorrhage From Esophageal Varices Secondary to Cirrhosis of the Liver , Surgery 41:94-101 ( (Jan) ) 1957. 15. Ludington, L.G.: A Study of 158 Cases of Esophageal Varices , Surg Gynec Obstet 106:519-526 ( (May) ) 1958. 16. Orloff, M.J.: A Comparative Study of Emergency Transesophageal Ligation and Non-surgical Treatment of Bleeding Esophageal Varices in Unselected Patients With Cirrhosis , Surgery 52:103-116 ( (July) ) 1962. 17. Johnson, G., Jr., et al: Hemodynamic Changes With Cirrhosis of the Liver , Ann Surg 163:692-703 ( (May) ) 1966.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1969

References