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Selective operative approach for variceal hemorrhage
American Journal of Surgery
|January 1, 1984
Summary
Selective surgical approaches for variceal hemorrhage, based on patient factors, yielded a 12% operative mortality. Patient outcomes varied by procedure type, with nonselective shunts linked to encephalopathy and distal splenorenal shunts to ascites.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Management of variceal hemorrhage historically relied on preoperative patient assessment.
- Surgical interventions aim to reduce mortality and complications associated with gastrointestinal bleeding.
Purpose of the Study:
- To evaluate the outcomes of selective surgical management for variceal hemorrhage.
- To compare the efficacy and complications of different surgical procedures.
Main Methods:
- Retrospective analysis of 116 consecutive patients undergoing surgical management for variceal hemorrhage since 1978.
- Procedures included distal splenorenal shunt, nonselective shunts, and nonshunting operations.
- Patient selection was based on preoperative hemodynamic and clinical factors.
Main Results:
- Overall operative mortality was 12%, with higher risk associated with Child's class.
- Postoperative complications included encephalopathy (20%), ascites (23%), and recurrent hemorrhage (11%).
- Encephalopathy was more frequent after nonselective shunts, while ascites was more common after distal splenorenal shunts.
Conclusions:
- A selective operative approach for variceal hemorrhage demonstrated acceptable mortality and survival rates.
- Procedure-specific complications necessitate careful patient selection.
- Neither procedure type nor liver disease etiology impacted long-term survival.