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Effect of delayed operation for bleeding esophageal varices on Child's class and indices of liver function
1Department of Surgery, University of Utah, Salt Lake City 84132.
Insights
Delayed surgery for bleeding esophageal varices did not improve liver function or patient outcomes. Early surgical intervention after stabilization is recommended for patients requiring a shunt, especially those with advanced liver disease.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Bleeding esophageal varices are a serious complication of portal hypertension.
- The optimal timing for surgical intervention, specifically portosystemic shunting, remains a subject of debate.
- Previous approaches involved a period of intensive medical management before surgery.
Purpose of the Study:
- To evaluate the impact of delayed surgical intervention on patient outcomes.
- To compare the efficacy of early versus delayed portosystemic shunting in patients with bleeding esophageal varices.
- To determine if preoperative medical management improves liver function or reduces operative mortality.
Main Methods:
- Retrospective chart review of 38 patients undergoing portosystemic shunting after a period of intensive medical treatment (mean 7 days).
- Comparison of operative mortality rates across different Child's classifications (A, B, C).
- Subsequent review and comparison of 10 Child's C patients operated on early (mean 3 days) versus 8 Child's C patients with delayed operation.
Main Results:
- Operative delay did not significantly improve Child's class or liver function indices.
- Operative mortality rates were 0% for Child's A, 13% for Child's B, and 50% for Child's C patients with delayed surgery.
- No significant difference in outcomes was observed between early and delayed surgery groups in Child's C patients.
Conclusions:
- Preoperative intensive medical management does not appear to benefit patients undergoing portosystemic shunting.
- Early surgical intervention after bleeding esophageal varices have ceased and the patient is stabilized is recommended.
- Prompt shunting may improve outcomes for patients with advanced liver disease (Child's C).
Abstract:
The charts of 38 patients managed with a period of intensive medical treatment (mean 7 days) prior to portosystemic shunting were examined. We found that the operative delay did not improve the Child's class or the indices of liver function. The operative mortality rates in these patients were 0 in Child's A patients, 13 percent in Child's B patients, and 50 percent in Child's C patients. Based on these findings, we began to operate on patients with bleeding esophageal varices as soon as they stabilized. The charts of 10 consecutive Child's C patients operated on without a period of intensive medical management (mean 3 days) were reviewed and compared with the charts of 8 Child's C patients with delayed operation. The two groups of patients were similar. We recommend that patients who need a shunt should be operated on as soon as possible after bleeding has ceased.