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Nonshunting Operations for Variceal Hemorrhage

1990; Elsevier BV; Volume: 70; Issue: 2 Linguagem: Inglês

10.1016/s0039-6109(16)45090-5

1558-3171

Marvin J. Wexler, Barry Stein,

Abdominal Trauma and Injuries

There is a resurgence of interest in and a quest for a simple and effective nonshunting operation for control of variceal hemorrhage that will avoid the effects of encephalopathy and decreased hepatic perfusion. Stapled esophageal transection has proved rapid and effective for emergent situations but has failed to improve the dismal survival in class C alcoholic cirrhotics. Varying degrees of transabdominal esophagogastric devascularization have been added, to decrease late rebleeding, with some success. The Sugiura procedure, in which the esophagus and upper stomach are meticulously stripped of all vessels, is unique in preserving the coronary and paraesophageal veins as a potential direct shunt to the azygous vein and has been shown to be extremely effective, but its role has been demonstrated only in a highly selective, predominantly nonalcoholic population in the elective situation. Numerous newer modifications and results are discussed.