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Emergency oesophageal transection for uncontrolled variceal bleeding.
Acta Chirurgica Scandinavica. Supplementum
|January 1, 1986
Summary
Transabdominal oesophageal transection using a mechanical stapler effectively controlled bleeding oesophageal varices in nine patients. This emergency procedure offers a viable option when conservative treatments fail, though long-term follow-up is needed.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Hepatology
Background:
- Bleeding oesophageal varices pose a significant risk, especially in patients unresponsive to conservative management.
- Emergency surgical intervention is sometimes necessary for life-threatening variceal hemorrhage.
- Current treatment options have limitations, necessitating exploration of alternative surgical techniques.
Purpose of the Study:
- To evaluate the efficacy and safety of emergency transabdominal oesophageal transection with a mechanical stapler for bleeding oesophageal varices.
- To assess the short-term and long-term outcomes of this surgical approach.
Main Methods:
- Nine patients with refractory bleeding oesophageal varices underwent emergency transabdominal oesophageal transection and reanastomosis using the EEA stapling instrument.
- Patients were classified using the Child-Pugh score (2 Class A, 4 Class B, 3 Class C).
Main Results:
- Complete hemorrhage control was achieved in all nine patients immediately post-procedure.
- Three patients (33%) died postoperatively due to hepatic failure, sepsis, and circulatory insufficiency.
- One patient experienced recurrent variceal bleeding at 15 and 23 months; another bled due to clip slippage at 17 months.
- One patient required esophageal stricture dilatation; no anastomotic leakage or hepatic encephalopathy occurred.
- Five patients (56%) remain alive and symptom-free at 6 to 32 months post-surgery.
Conclusions:
- Transabdominal oesophageal transection with the EEA stapler is a potentially useful procedure for controlling exsanguinating oesophageal varices when other methods fail.
- While effective in achieving initial hemostasis, further experience and longer follow-up are required to definitively establish its role and long-term efficacy.