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Related Concept Videos

Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Peptic Ulcer Disease V: Surgical Management and Nursing Care01:25

Peptic Ulcer Disease V: Surgical Management and Nursing Care

Surgical management and nursing care are crucial in treating Peptic Ulcer Disease (PUD). Here is an organized and enhanced overview of the surgical interventions and the associated nursing care for PUD:
Surgical Interventions for Peptic Ulcer Disease
Varicose Veins II: Diagnostic Studies and Interprofessional Care01:26

Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...

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Related Experiment Video

Updated: Jul 12, 2026

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

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Should ablative operations be used for bleeding esophageal varices?

B A Keagy, J A Schwartz, G Johnson

    Annals of Surgery
    |May 1, 1986
    PubMed
    Summary

    This study reviewed the Womack operation for esophageal varices, finding a high 35% operative mortality. Long-term survival varied by patient class, with recurrent bleeding common.

    Area of Science:

    • Gastroenterology
    • Surgical Oncology
    • Hepatology

    Background:

    • Esophageal varices pose a significant bleeding risk in patients with portal hypertension.
    • Previous ablative surgical procedures for esophageal varices have shown variable success rates.
    • The Womack operation is a non-shunt ablative procedure for managing esophageal varices.

    Purpose of the Study:

    • To evaluate the long-term clinical outcomes and survival following the Womack operation for esophageal varices.
    • To assess the efficacy and safety of non-shunt ablative surgery in managing esophageal varices.

    Main Methods:

    • Retrospective review of 60 Womack operations performed between 1953 and 1974.
    • Analysis of operative mortality, long-term survival rates (Kaplan-Meier), and rebleeding incidence.

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  • Comparison with collected data from other ablative esophageal variceal operations.

    • Main Results:

    • Overall operative mortality was high at 35%.
    • Five-year survival rates for Child's classes A, B, and C were 100%, 63%, and 33%, respectively (excluding operative deaths).
    • Actuarial survival was 40% at 5 years, 24% at 10 years, and 15% at 15 years. Recurrent bleeding occurred in 54% of patients, with no identifiable predictors.

    Conclusions:

    • The Womack operation, an ablative procedure without esophageal transection, is associated with high mortality and rebleeding rates.
    • This procedure should be reserved for highly selected patients unsuitable for venous shunt procedures.
    • Alternative management strategies should be considered due to the generally unacceptable outcomes of ablative operations for esophageal varices.