[Surgical management of the gastroesophageal varices--experience with 118 cases]

Between June 1968 and May 1982, 118 patients with esophagogastric varices due to portal hypertension were treated and one hundred thirteen of these underwent surgical interventions. Ninety-eight patients had liver cirrhosis, fourteen were diagnosed idiopathic portal hypertension and one was diagnosed extrahepatic portal obstruction. More progressed impairment of hepatic function and severe manifestation of clinical symptoms were observed in the cirrhotics, compared with those in non-cirrhotics. We preferred the one-staged combined procedure of transthoracic esophageal transection, transdiaphragmatic splenectomy and paraesophagogastric devascularization, because of its therapeutic effectiveness and technical feasibility. Splenectomy with or without proximal gastrectomy was chosen for the remaining small number of the patients. While the overall operative mortality was 12.4%, 14 patients (13.5%) succumbed within a month after esophageal transection. These procedures were contraindicated for the patient with uncontrollable ascites, jaundice and encephalopathy and should be carried out electively because of high mortality of emergent operation.