Surgery for bleeding esophageal varices

A total of 72 patients were operated for bleeding esophageal varices over five years. Cause of portal hypertension was cirrhosis in 33, Schistosomal fibrosis in 23 and a combination of the two diseases in 3 cases. Biopsy was not available in 13 patients. Fifty-eight patients were child grade A and B, while 14 patients were grade C. Overall, there were 16 hospital deaths (22.2%) and 28 patients had complications (38.8%). Specifically, Hassab's operation was done in 40 patients with 12.5% mortality and 11.7% incidence of rebleeding. Hassab's operation plus esophageal transection in 13 patients was associated with 46.1% mortality and no incidence of rebleeding. Warren's splenorenal shunt, done in 11 patients, was accompanied by 1 (9%) death and no incidence of rebleeding. Mortality rate increased significantly when esophageal transection was added to Hassab's operation. It is concluded that for low risk patients being operated electively, Warren's shunt is an acceptable alternative to Hassab's operation which is better suited to emergency situations. Esophageal transection should not be added to Hassab's operation because this increases the mortality.