A transthoracic devascularization procedure for control of bleeding esophageal varices: preliminary report

A procedure for control of variceal bleeding has been described which involves "devascularization" of the distal one third of the esophagus and upper one half of the stomach combined with a Nissen fundoplication performed through a left lateral thoracotomy and an incision in the left diaphragm. Transection of the truncal vagi is required to effectively de vascularize the distal esophagus and, thus, pyloromyotomy or pyloroplasty is added. Six patients who were moderately high risk candidates underwent this procedure for control for persistent hemorrhage; five of these patients were operated on within 48 hours of admission. There was one postoperative mortality. The five survivors have not rebled, and there has been no evidence of encephalopathy or progressive liver deterioration over a mean follow-up of thirteen months.