Abstract INTRODUCTION Although many operations have been devised for the treatment of bleeding esophageal varices secondary to cirrhosis of the liver, at present only three procedures are in fairly common usage. These are (1) the shunting of portal blood to the caval system, (2) the transesophageal ligation of the varices, and (3). the resection of the cardio-esophageal region with esophagogastrostomy.The advocates of the shunt operations emphasize the importance of lowering the portal hypertension, which is believed to be responsible for the development of the varices.* This may be accomplished by a satisfactory anastomosis between the portal or splenic veins and the inferior vena cava or left renal vein. Evidence of the reduction of portal pressure has been obtained at the operating table by measuring the portal pressure before and after the shunt has been performed † and also in the postoperative period by measuring the pressure in the varix through References 1. References 4, 5, 11. 21, and 22. 2. References 4 and 5. 3. References 4, 5, and 11. 4. References 8, 15, and 18; Blalock, A., discussion on Linton.11 5. References 8, 15, and 18; Berne, C. J., in discussion on Pattison 3; Holden, D. W., in discussion on Berman and Hull.9 6. References 19 and 20. 7. Berman, E. F., personal communication. 8. " The Use of a Triple-Lumen Single-Balloon in the Diagnosis and Treatment of Massive Upper Gastrointestinal Hemorrhage ," Surgery 38:667, 1955. 9. References 17 and 13. 10. Berman, E. F.: The Experimental Replacement of Portions of the Esophagus by a Plastic Tube , Ann. Surg. 135:337, 1952.Crossref 11. Berman, E. F.: Carcinoma of the Esophagus: A New Concept in Therapy , Surgery 35:822, 1954. 12. Pattison, A. C.: Use of Portacaval Anastomosis in Portal Cirrhosis , Arch. Surg. 58:590, 1949.Crossref 13. Blakemore, A. H.: Portacaval Shunting for Portal Hypertension , Surg., Gynec. & Obst. 94:443, 1952. 14. Child, C. G., and others: The Hepatic Circulation and Portal Hypertension , Philadelphia and London, W. B. Saunders Company, 1954, Chap. 13 . 15. Crile, G., Jr.: Transesophageal Ligation of Bleeding Esophageal Varices: Preliminary Report of Cases , Arch. Surg. 61:654, 1950. 16. Garlock, J. H., and Som, M. L.: Further Observations on Packing of the Mediastinum for Esophageal Varices , J. Thoracic Surg. 19:572, 1950. 17. Gray, H. K., and Whitesell, F. B., Jr.: Hemorrhage from Esophageal Varices: Surgical Management , Ann. Surg. 132:798, 1950. 18. Berman, J. K., and Hull, J. E.: Hypertension and Its Relation to Hepatic Circulation: Effects on Arterial Pressure of Variations in Blood Supply of the Liver in Normotensive, Hypertensive, and Portal Cirrhotic Dogs, and in Hypertensive Patients with Portal Cirrhosis , A. M. A. Arch. Surg. 65:430, 1952. 19. Jahnke, E. J., Jr.; Palmer, E. D.; Sborov, V. M.; Hughes, C. W., and Seeley, S. F.: An Evaluation of the Shunt Operation for Portal Decompression , Surg., Gynec. & Obst. 97:471, 1953. 20. Linton, R. R.: The Selection of Patients for Portacaval Shunts with a Summary of the Results in 61 Cases , Ann. Surg. 134:433, 1951. 21. Linton, R. R.: The Emergency and Definitive Treatment of Bleeding Esophageal Varices , Gastroenterology 24:1, 1953. 22. Linton, R. R.: The Surgical Treatment of Bleeding Esophageal Varices by Portal Systemic Venous Shunts with a Report of 34 Cases , Ann. Int. Med. 31:794, 1949. 23. Nachlas, M. M.; O'Neil, J. E., and Campbell, A. J. A.: The Life History of Patients with Cirrhosis of the Liver and Bleeding Esophageal Varices , Ann. Surg. 141:10, 1955. 24. Ogilvie, H.: Peptic Ulceration and Gastrointestinal Hemorrhage , Surgery 34:768, 1953. 25. Phemister, D. B., and Humphreys, E. M.: Gastro-Esophageal Resection and Total Gastrectomy in the Treatment of Bleeding Varicose Veins in Banti's Syndrome , Ann. Surg. 126:397, 1947. 26. Ratnoff, O. D., and Patek, A. J., Jr.: The Natural History of Laennec's Cirrhosis of the Liver: An Analysis of 386 Cases , Medicine 21:207, 1942. 27. Ripstein, C. B.: Experiences with Portacaval Anastomosis in the Treatment of Portal Hypertension , Surgery 34:570, 1953. 28. Schafer, P. W., and Kittle, C. F.: Partial Esophagogastrectomy in the Treatment of Esophagogastric Varices , Arch. Surg. 61:235, 1950. 29. Sheline, G. E.; Clark, D. E.; Adams, W. E., and Phemister, D. B.: Symposium on Gastroesophageal Surgery: Partial Gastroesophagectomy for Esophageal Varices , S. Clin. North America 31:213, 1951. 30. Welch, C. S.: Medical Progress: Portal Hypertension , New England J. Med. 243:598, 1950.Crossref 31. Whipple, A. O.: The Problem of Portal Hypertension in Relation to the Hepatosplenopathies , Ann. Surg. 122:449, 1945.Crossref
A.M.A. Archives Surgery – American Medical Association
Published: Apr 1, 1956
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