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Mortality and rebleeding after hypertensive variceal disconnections
Archives of Surgery (Chicago, Ill. : 1960)
|April 1, 1984
Summary
Surgical disconnection of portoazygos venous collaterals for variceal hemorrhage showed high mortality in alcoholic patients. Complete azygos disconnection is a viable option for nonalcoholic patients, especially electively.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatology
Background:
- Variceal hemorrhage is a serious complication of portal hypertension.
- Portoazygos venous collaterals are surgically disconnected to manage bleeding.
- Alcoholic liver disease often complicates management and prognosis.
Purpose of the Study:
- To evaluate the outcomes of operative disconnections of portoazygos venous collaterals for variceal hemorrhage.
- To compare urgent versus elective procedures.
- To assess the efficacy of partial versus complete azygos disconnection.
Main Methods:
- Forty-five patients underwent operative disconnection of portoazygos venous collaterals.
- Nineteen alcoholic patients had urgent partial azygos disconnection (PAD).
- Fourteen patients had urgent complete azygos disconnection (CAD), and 12 had elective CAD, with splenectomy included in CAD.
Main Results:
- Hospital mortality was 67% for urgent PAD or CAD in alcoholics, primarily due to sepsis or hepatorenal failure.
- Survivors had a better modified Child's classification than nonsurvivors.
- Eleven nonalcoholic patients underwent CAD; two died, while nine survivors had no rebleeding or encephalopathy during follow-up.
Conclusions:
- Urgent PAD or CAD in alcoholic patients carries a high mortality risk.
- Complete azygos disconnection is a suitable alternative for nonalcoholic patients with portal hypertension, particularly when performed electively.
- Surgical management requires careful patient selection based on operative risk and etiology of portal hypertension.