Salvage surgery in variceal bleeding due to portal hypertension

A proportion (10%-15%) of patients with variceal bleeding do not respond to medical management and require surgical intervention.

Retrospective analysis of 82 consecutive patients (median age 31 years, range 3-71; 60 male) who underwent salvage surgery for variceal bleeding between 1989 and 2005.

Immediate control of variceal bleeding was achieved in 78 (95%) patients. Four patients (cirrhosis 3, portal vein block 1) continued to bleed in the postoperative period following gastro-esophageal devascularization (3) or portacaval shunt (1). Twelve (15%) patients died in hospital; the commonest cause of death (n=7) was liver failure and sepsis leading to multi-system organ failure. The mortality rate was higher among patients who had undergone emergency surgery for active bleeding than among those who had been adequately resuscitated and evaluated prior to surgery (12/45 vs. 0/37; p< 0.001). Mortality rate tended to be higher in patients with cirrhosis (overall 10/45 [22%]; Child A 1/9 [11%], Child B 4/20 [20%], Child C 5/16 [31%]) than in those with non-cirrhotic portal hypertension (3/37 [8%]; p=ns).

Our data suggest that salvage surgery is justified in patients with variceal bleed in whom non-surgical measures fail.