SELECTION OF OPERATION IN PATIENTS WITH BLEEDING ESOPHAGEAL-VARICES

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  • 1 January 1978
    • journal article
    • research article
    • Vol. 118  (4) , 369-372
Abstract
The results of surgical treatment of bleeding esophageal varices over an 8 yr period in 155 patients are reviewed. Primary treatment of bleeding was conservative, with i.v. administration of vasopressin and balloon tamponade. Emergency operations were carried out after 48 h in persons with persistent bleeding who were surgical candidates. Operative mortality was higher in this group (40%) than in those undergoing elective or urgent operations (each 10%). Postoperative encephalopathy occurred in 35% of patients and was correlated closely to late death after establishment of a shunt. The mesocaval shunt is no better than the portacaval but appears to be a good alternative in an emergency. In a controlled trial the distal splenorenal shunt was found to be associated with a lower rate of postoperative encephalopathy than the portacaval shunt, but thus far the long-term survival rates have not differed.