Subserosal variceal ligation for gastric varices

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Gastric varices (GV) can persist after standard surgical treatments like paragastroesophageal devascularization and splenectomy (GEDS).
• Endoscopic surveillance is crucial for identifying residual GV post-GEDS.
• Effective management of residual GV is essential to prevent complications.

Purpose of the Study:

• To evaluate the efficacy of additional subserosal variceal ligation (SSVL) after GEDS for immediate clearance of residual gastric varices.
• To assess the safety and effectiveness of the combined GEDS and SSVL surgical technique.

Main Methods:

• A cohort of eight patients with residual GV after GEDS underwent additional SSVL.
• The SSVL procedure involved intraoperative endoscopic identification of GV, followed by serosal incision, ligation with 3-0 silk, and closure with sutures.
• Patients were monitored via endoscopy post-procedure and after discharge.

Main Results:

• All eight patients achieved complete disappearance of gastric varices immediately after SSVL.
• Post-discharge endoscopic examinations confirmed the absence of intraluminal bleeding and persistent GV.
• The combined GEDS and SSVL technique demonstrated immediate effectiveness.

Conclusions:

• Subserosal variceal ligation (SSVL) is a simple and effective adjunct to GEDS for the immediate eradication of gastric varices.
• This combined surgical approach offers a reliable solution for managing residual GV after initial devascularization and splenectomy.