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Transthoracic cardiectomy with infraesophago-supragastric devascularization for bleeding esophageal varices
Insights
A novel transthoracic surgical approach for esophageal varices offers a safer alternative for high-risk patients, including those with severe liver dysfunction or emergency bleeding.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Innovation
- Portal Hypertension Management
Background:
- Esophageal varices pose a significant bleeding risk in patients with portal hypertension.
- Transabdominal surgical approaches can place considerable load on the liver.
- Existing treatments for bleeding esophageal varices have limitations, especially in high-risk individuals.
Purpose of the Study:
- To introduce and evaluate a new transthoracic operative procedure for esophageal varices.
- To assess the safety and efficacy of this approach in high-risk patients.
- To overcome the shortcomings of previous surgical methods for portal hypertension.
Main Methods:
- A transthoracic approach involving cardiectomy and complete devascularization of the lower esophagus and upper stomach was developed.
- Twenty patients with portal hypertension underwent the new procedure.
- Patient cohort included individuals with severe hepatic dysfunction, emergency bleeding, and prior surgeries.
Main Results:
- No operative deaths occurred in the series of 20 patients.
- Three cirrhotic patients with severe hepatic dysfunction died during late follow-up.
- Seventeen patients experienced uneventful postoperative courses with no recurrence of esophageal bleeding over a 20-month follow-up period.
Conclusions:
- The described transthoracic procedure is a safe and effective option for managing esophageal varices, particularly in high-risk patients.
- This technique potentially offers an advantage over traditional transabdominal methods by reducing liver load.
- The procedure demonstrates promise in preventing recurrent esophageal bleeding in patients with portal hypertension.
Abstract:
Based on the thoughts that transthoracic approaches give less load to liver than transabdominal ones, and that effectiveness for bleeding esophageal varices is secured by cardiectomy with complete devascularization of lower esophagus and upper stomach, a new operative procedure for esophageal varices is described which is more safely applicable to the risky patients. Twenty cases with portal hypertension were operated, including eight cirrhotic patients with severe hepatic dysfunction, six cases of emergency bleeding and six reoperated cases. No operative death was encountered, but three cirrhotic patients died during the late follow up period. The remaining 17 patients had uneventful postoperative courses without recurrence esophageal bleeding during 20 months follow up period. Thus this operation may eliminate the shortcoming of previous operative methods for portal hypertension.