[A new operation for the management of gastric varix bleeding]

Gastric varices is a special oriental type manifestation of gastroesophageal collaterals in portal hypertension patients. It has gained more attention in recent years following the popularity of endoscopy and sclerotherapy. Catastrophic bleeding from ruptures of gastric varices is a life threatening emergency. Gastric varices are generally located at the greater curvature side of the cardiofundic region. Neither a Sengstaken-Blakemore balloon tube nor a Linton balloon tube can stop the bleeding. This area is also beyond the field of sclerotherapy. Surgery is the only definite therapy. Devascularization procedures as described by Dr. Hassab sometimes fail to control active bleeding and also fail to adequately decongest the whole varices area. The radical resection procedures such as terminal esophagectomy, proximal gastrectomy or cardiectomy as proposed by Japanese groups interrupts the normal esophgo-gastric continuity and is also too invasive for a cirrhotic patient. In between, besides terminal esophago-proximal gastric devascularization and splenectomy, we use a TA-90 stapler to perform an oblique cardiofundectomy to resect en bloc the tortuous gastric varices area. From Nov. 1983 to May 1988, at the Veterans General Hospital-Taipei, 16 patients received this new operation to manage gastric varices bleeding. Ten of them were on an emergency basis and 6 were elective surgery. Only one patient in the emergency group died. All catastrophic bleeding in the emergency group was dramatically controlled and all other patients recovered rapidly. With a follow-up range from 6 months to 4.5 year and an average of 19 months, there was no recurrent bleeding and no hepatic encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)