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Treatment of Bleeding Esophageal Varices in Portal-Systemic Shunt Failures: By Extensive Gastrectomy, Esophagogastrectomy, or Total Esophagectomy

Treatment of Bleeding Esophageal Varices in Portal-Systemic Shunt Failures: By Extensive... Abstract In some patients with massive hemorrhage from esophageal varices, and particularly in extrahepatic portal obstruction, shunting procedures fail to prevent further significant bleeding or are technically impossible. For this relatively small group of patients with portal hypertension, a variety of approaches have been proposed, including varix ligation,1 hepatic or splenic arterial ligation,2 injection of sclerosing agents,3 omentopexy,4 mediastinal packing,5 gastric and esophageal transection and resuture,6-8 and gastric and esophageal resection. These latter operations have been designed either to excise the acid-secreting portions of the stomach and thereby prevent acidpeptic erosion of the mucosal covering of the varices, or to excise the varix tissue itself. The introduction of procedures involving excision of the stomach and esophagus occurred during the same years that the potral-systemic shunt procedures were first clinically introduced on a broad scale (Table 1).9-14 However, the number of patients subjected to such References 1. Boerema, I.: Bleeding Varices of the Esophagus in Cirrhosis of the Liver and Banti's Syndrome , Arch Chir Neerl 1:253-260 ( (Dec) ) 1949. 2. Rienhoff, W.F.: Ligation of the Hepatic and Splenic Arteries in the Treatment of Portal Hypertension and a Report of Six Cases , Bull Hopkins Hosp 88:368-375 ( (July) ) 1951. 3. Crafoord, C., and Frenckner, P.: Non-Surgical Treatment of Varicose Veins of the Esophagus , Acta Otolaryng 27( (pt 4) ):422-429, 1939.Crossref 4. Drummond, D., and Morison, R.: A Case of Ascites Due to Cirrhosis of the Liver Cured by Operation , Brit Med J 2:728-729 ( (Sept 19) ) 1896. 5. Som, M.L., and Garlock, J.H.: New Approach to Treatment of Esophageal Varices , JAMA 135:628-629 ( (Nov 8) ) 1947.Crossref 6. Tanner, N.C.: Hemorrhage as a Surgical Emergency , Proc Roy Soc Med 43:147-152 ( (Feb) ) 1950. 7. Tanner, N.C.: The Late Results of Porto-Azygos Disconnection in the Treatment of Bleeding From Oesophageal Varices , Ann Roy Coll Surg Eng 28:153, 1961. 8. Walker, R.M.: Transection Operations for Portal Hypertension , Thorax 15:218-224 ( (Sept) ) 1960.Crossref 9. 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 126:397-407 ( (Oct) ) 1947.Crossref 10. Wangensteen, O.H.: The Ulcer Problem (Listerian Oration) , Canad Med Assoc J 53:309-330 ( (Oct) ) 1945. 11. Whipple, A.O.: The Problem of Portal Hypertension in Relation to the Hepatosplenopathies , Ann Surg 122:449-475 ( (Oct) ) 1945.Crossref 12. Blakemore, A.H., and Lord, J.W., Jr.: The Technique of Using Vitallium Tubes in Establishing Portacaval Shunts for Portal Hypertension , Ann Surg 122:476-489 ( (Oct) ) 1945.Crossref 13. Cooley, D.A., and DeBakey, M.E.: Esophagectomy for Bleeding Esophageal Varices , Arch Surg 68:854-871 ( (June) ) 1954.Crossref 14. Perry, J.G., et al: Total Removal of the Intrathoracic Esophagus and Antethoracic Jejunal Esophageal Replacement for Treatment of Esophageal Varices Due to Extra-Hepatic Portal Block , Ann Surg 158:126-128 ( (July) ) 1963.Crossref 15. Baronofsky, I.D., and Wangensteen, O.H.: Obstruction of Splenic Vein Increases Weight of Stomach and Predisposes to Erosion or Ulcer , Proc Soc Exp Biol Med 59:234-238, 1945.Crossref 16. Baronofsky, I.D.: Portal Hypertension: With Special Reference to the Acid-Peptic Factor in the Causation of Hemorrhage and Extensive Gastric Resection in Its Treatment , Surgery 25:135-168 ( (Jan) ) 1949. 17. Wagenknecht, T.W., Noble, J.F., and Baronofsky, I.D.: Nature of Bleeding in Esophageal Varices , Surgery 33:869-874 ( (June) ) 1953. 18. Orloff, M.J., and Thomas, H.S.: Pathogenesis of Esophageal Varix Rupture , Arch Surg 87:301-307 ( (Aug) ) 1963.Crossref 19. Hunt, A.H.: A Contribution to the Study of Portal Hypertension , London: E & S Livingstone, Ltd., 1958, pp 101-108. 20. Womach, N.A.: Discussion of Paper by Gray and Whitesell , Ann Surg 132:808 ( (Oct) ) 1950. 21. Schafer, P.W., and Kittle, C.F.: Partial Esophagogastrectomy for Esophageal Varices , Arch Surg 61:235-243 ( (Aug) ) 1950.Crossref 22. Antivenin (Crotalidae) Polyvolent, Splenic Studies. II. Portal Hypertension in Children Associated With Gastroesophageal Hemorrhage , Arch Surg 65:499-510 ( (Oct) ) 1952.Crossref 23. Habif, D.: Treatment of Esophageal Varices by Partial Esophagogastrectomy and Interposed Jejunal Segment , Surgery 46:212-235 ( (July) ) 1959. 24. Arcari, F.A., and Lynn, H.B.: Bleeding Esophageal Varices in Children , Surg Gynec Obstet 112:101-105 ( (Jan) ) 1961. 25. Koop, C.E., and Roddy, R.: Colonic Replacement of Distal Esophagus and Proximal Stomach in the Management of Bleeding Varices in Children , Ann Surg 147:17-25 ( (Jan) ) 1958.Crossref 26. Koop, C.E., and Kavianian, A.: Reappraisal of Colonic Replacement of Distal Esophagus and Proximal Stomach in the Management of Bleeding Varices in Children , Surgery 57:454-456 ( (March) ) 1965. 27. MacPherson, A.I.S., and Innes, J.: Late Results of Esophagogastrectomy for Portal Hypertension , Lancet 1:999-1002 ( (May 8) ) 1965.Crossref 28. Voorhees, A.B., et al: Portal Hypertension in Children: 98 Cases , Surgery 58:540-549 ( (Sept) ) 1965. 29. Sheline, G.E., et al: Partial Gastroesophagectomy for Esophageal Varices , Surg Clin N Amer 31:213-227 ( (Feb) ) 1951. 30. Patton, T.B., and Lyons, C.: Long-Term Results of the Phemister Procedure for Extra-Hepatic Postsplenectomy Portal Hypertension , Bull Soc Int Chir 17:260-269 ( (Sept) ) 1958. 31. Hallenbeck, G.A., and Adson, M.A.: Esophagogastric Varices Without Hepatic Cirrhosis , Arch Surg 83:370-383 ( (Sept) ) 1961.Crossref 32. Ekman, C.A., and Sandblom, P.: The Surgical Treatment of Portal Hypertension , Acta Chir Scand 108:241-260, 1954-1955. 33. Merendino, K.A., and Dillard, D.H.: The Concept of Sphincter Substitution by an Interposed Jejunal Segment for Anatomic and Physiologic Abnormalities at the Esophagogastric Junction , Ann Surg 142:486-506 ( (Sept) ) 1955.Crossref 34. King, H., and Shumacker, H.B.: Venous Shunt Procedures for Portal Hypertension in Children , Surgery 43:680-682 ( (April) ) 1958. 35. Clatworthy, H.W., Jr., and Boles, E.T., Jr.: Extrahepatic Portal Bed Block in Children: Pathogenesis and Treatment , Ann Surg 150:371-383 ( (Sept) ) 1959.Crossref 36. Klopper, P.J.: Slokdarm-Maagersectie voor Varices in de Slokdarm , Nederl T Geneesk 104:954-957 ( (May 7) ) 1960. 37. Trusler, G.A.; Morris, F.R; and Mustard, W.T.: Portal Hypertension in Childhood , Surgery 52:664-670 ( (Oct) ) 1962. 38. Shaldon, S., and Sherlock, S.: Obstruction to the Extra-Hepatic Portal System in Childhood , Lancet 1:63-67 ( (Jan 13) ) 1962.Crossref 39. Foster, J.H.; Holcomb, G.W.; and Kirtley, J.A.: Results of Surgical Treatment of Portal Hypertension in Children , Ann Surg 157:868-881 ( (June) ) 1963.Crossref 40. Gross, R.E., and Firestone, F.N.: Colonic Reconstruction of the Esophagus in Infants and Children , Surgery 61:955-964 ( (June) ) 1967. 41. Marion, P.: Les Obstructiones Portales , Sem Hop Paris 29:2,781, 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Treatment of Bleeding Esophageal Varices in Portal-Systemic Shunt Failures: By Extensive Gastrectomy, Esophagogastrectomy, or Total Esophagectomy

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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.1969.01340140043007
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Abstract

Abstract In some patients with massive hemorrhage from esophageal varices, and particularly in extrahepatic portal obstruction, shunting procedures fail to prevent further significant bleeding or are technically impossible. For this relatively small group of patients with portal hypertension, a variety of approaches have been proposed, including varix ligation,1 hepatic or splenic arterial ligation,2 injection of sclerosing agents,3 omentopexy,4 mediastinal packing,5 gastric and esophageal transection and resuture,6-8 and gastric and esophageal resection. These latter operations have been designed either to excise the acid-secreting portions of the stomach and thereby prevent acidpeptic erosion of the mucosal covering of the varices, or to excise the varix tissue itself. The introduction of procedures involving excision of the stomach and esophagus occurred during the same years that the potral-systemic shunt procedures were first clinically introduced on a broad scale (Table 1).9-14 However, the number of patients subjected to such References 1. Boerema, I.: Bleeding Varices of the Esophagus in Cirrhosis of the Liver and Banti's Syndrome , Arch Chir Neerl 1:253-260 ( (Dec) ) 1949. 2. Rienhoff, W.F.: Ligation of the Hepatic and Splenic Arteries in the Treatment of Portal Hypertension and a Report of Six Cases , Bull Hopkins Hosp 88:368-375 ( (July) ) 1951. 3. Crafoord, C., and Frenckner, P.: Non-Surgical Treatment of Varicose Veins of the Esophagus , Acta Otolaryng 27( (pt 4) ):422-429, 1939.Crossref 4. Drummond, D., and Morison, R.: A Case of Ascites Due to Cirrhosis of the Liver Cured by Operation , Brit Med J 2:728-729 ( (Sept 19) ) 1896. 5. Som, M.L., and Garlock, J.H.: New Approach to Treatment of Esophageal Varices , JAMA 135:628-629 ( (Nov 8) ) 1947.Crossref 6. Tanner, N.C.: Hemorrhage as a Surgical Emergency , Proc Roy Soc Med 43:147-152 ( (Feb) ) 1950. 7. Tanner, N.C.: The Late Results of Porto-Azygos Disconnection in the Treatment of Bleeding From Oesophageal Varices , Ann Roy Coll Surg Eng 28:153, 1961. 8. Walker, R.M.: Transection Operations for Portal Hypertension , Thorax 15:218-224 ( (Sept) ) 1960.Crossref 9. 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 126:397-407 ( (Oct) ) 1947.Crossref 10. Wangensteen, O.H.: The Ulcer Problem (Listerian Oration) , Canad Med Assoc J 53:309-330 ( (Oct) ) 1945. 11. Whipple, A.O.: The Problem of Portal Hypertension in Relation to the Hepatosplenopathies , Ann Surg 122:449-475 ( (Oct) ) 1945.Crossref 12. Blakemore, A.H., and Lord, J.W., Jr.: The Technique of Using Vitallium Tubes in Establishing Portacaval Shunts for Portal Hypertension , Ann Surg 122:476-489 ( (Oct) ) 1945.Crossref 13. Cooley, D.A., and DeBakey, M.E.: Esophagectomy for Bleeding Esophageal Varices , Arch Surg 68:854-871 ( (June) ) 1954.Crossref 14. Perry, J.G., et al: Total Removal of the Intrathoracic Esophagus and Antethoracic Jejunal Esophageal Replacement for Treatment of Esophageal Varices Due to Extra-Hepatic Portal Block , Ann Surg 158:126-128 ( (July) ) 1963.Crossref 15. Baronofsky, I.D., and Wangensteen, O.H.: Obstruction of Splenic Vein Increases Weight of Stomach and Predisposes to Erosion or Ulcer , Proc Soc Exp Biol Med 59:234-238, 1945.Crossref 16. Baronofsky, I.D.: Portal Hypertension: With Special Reference to the Acid-Peptic Factor in the Causation of Hemorrhage and Extensive Gastric Resection in Its Treatment , Surgery 25:135-168 ( (Jan) ) 1949. 17. Wagenknecht, T.W., Noble, J.F., and Baronofsky, I.D.: Nature of Bleeding in Esophageal Varices , Surgery 33:869-874 ( (June) ) 1953. 18. Orloff, M.J., and Thomas, H.S.: Pathogenesis of Esophageal Varix Rupture , Arch Surg 87:301-307 ( (Aug) ) 1963.Crossref 19. Hunt, A.H.: A Contribution to the Study of Portal Hypertension , London: E & S Livingstone, Ltd., 1958, pp 101-108. 20. Womach, N.A.: Discussion of Paper by Gray and Whitesell , Ann Surg 132:808 ( (Oct) ) 1950. 21. Schafer, P.W., and Kittle, C.F.: Partial Esophagogastrectomy for Esophageal Varices , Arch Surg 61:235-243 ( (Aug) ) 1950.Crossref 22. Antivenin (Crotalidae) Polyvolent, Splenic Studies. II. Portal Hypertension in Children Associated With Gastroesophageal Hemorrhage , Arch Surg 65:499-510 ( (Oct) ) 1952.Crossref 23. Habif, D.: Treatment of Esophageal Varices by Partial Esophagogastrectomy and Interposed Jejunal Segment , Surgery 46:212-235 ( (July) ) 1959. 24. Arcari, F.A., and Lynn, H.B.: Bleeding Esophageal Varices in Children , Surg Gynec Obstet 112:101-105 ( (Jan) ) 1961. 25. Koop, C.E., and Roddy, R.: Colonic Replacement of Distal Esophagus and Proximal Stomach in the Management of Bleeding Varices in Children , Ann Surg 147:17-25 ( (Jan) ) 1958.Crossref 26. Koop, C.E., and Kavianian, A.: Reappraisal of Colonic Replacement of Distal Esophagus and Proximal Stomach in the Management of Bleeding Varices in Children , Surgery 57:454-456 ( (March) ) 1965. 27. MacPherson, A.I.S., and Innes, J.: Late Results of Esophagogastrectomy for Portal Hypertension , Lancet 1:999-1002 ( (May 8) ) 1965.Crossref 28. Voorhees, A.B., et al: Portal Hypertension in Children: 98 Cases , Surgery 58:540-549 ( (Sept) ) 1965. 29. Sheline, G.E., et al: Partial Gastroesophagectomy for Esophageal Varices , Surg Clin N Amer 31:213-227 ( (Feb) ) 1951. 30. Patton, T.B., and Lyons, C.: Long-Term Results of the Phemister Procedure for Extra-Hepatic Postsplenectomy Portal Hypertension , Bull Soc Int Chir 17:260-269 ( (Sept) ) 1958. 31. Hallenbeck, G.A., and Adson, M.A.: Esophagogastric Varices Without Hepatic Cirrhosis , Arch Surg 83:370-383 ( (Sept) ) 1961.Crossref 32. Ekman, C.A., and Sandblom, P.: The Surgical Treatment of Portal Hypertension , Acta Chir Scand 108:241-260, 1954-1955. 33. Merendino, K.A., and Dillard, D.H.: The Concept of Sphincter Substitution by an Interposed Jejunal Segment for Anatomic and Physiologic Abnormalities at the Esophagogastric Junction , Ann Surg 142:486-506 ( (Sept) ) 1955.Crossref 34. King, H., and Shumacker, H.B.: Venous Shunt Procedures for Portal Hypertension in Children , Surgery 43:680-682 ( (April) ) 1958. 35. Clatworthy, H.W., Jr., and Boles, E.T., Jr.: Extrahepatic Portal Bed Block in Children: Pathogenesis and Treatment , Ann Surg 150:371-383 ( (Sept) ) 1959.Crossref 36. Klopper, P.J.: Slokdarm-Maagersectie voor Varices in de Slokdarm , Nederl T Geneesk 104:954-957 ( (May 7) ) 1960. 37. Trusler, G.A.; Morris, F.R; and Mustard, W.T.: Portal Hypertension in Childhood , Surgery 52:664-670 ( (Oct) ) 1962. 38. Shaldon, S., and Sherlock, S.: Obstruction to the Extra-Hepatic Portal System in Childhood , Lancet 1:63-67 ( (Jan 13) ) 1962.Crossref 39. Foster, J.H.; Holcomb, G.W.; and Kirtley, J.A.: Results of Surgical Treatment of Portal Hypertension in Children , Ann Surg 157:868-881 ( (June) ) 1963.Crossref 40. Gross, R.E., and Firestone, F.N.: Colonic Reconstruction of the Esophagus in Infants and Children , Surgery 61:955-964 ( (June) ) 1967. 41. Marion, P.: Les Obstructiones Portales , Sem Hop Paris 29:2,781, 1953.

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1969

References