[Prospective evaluation of treatment results while using surgical esophageal devascularization and transection for...

During the years 1979-1996 over 300 patients aged 2-71, with esophageal varices had been treated in our Clinic. In 104 cases extended gastroesophageal devascularization and esophageal transection combined with splenectomy was performed. According to Child-Pugh's classification 60 patients (58%) were qualified to group A and B, 44 (42%)-to group C. In 61 cases (59%) the operations were carried out electively, in 30 (29%)-as an emergency and in the remaining 13 (12%)-prophylacticly. In all cases the operation was successful in controlling preoperative variceal bleeding. Postoperative mortality amounted in 20 cases (19%): in Child's group A and B-10% and in group C-32%. The highest mortality rate was noted in group C patients operated emergently (38%). The main cause of death was developing hepatic failure (18 cases) and esophageal fistula in the remaining 2. Recurrence of esophageal varices was observed in 4 patients (4%) and the recurrence of variceal bleeding in 3 of them (3%). In other 3 cases recurrent bleeding was caused by acute mucosal lesions in the stomach. No cases of postoperative encephalopathy have been observed. Follow-up period ranged from 2 months to 15 years (mean 6.5 years) and actuarial survival-67 patients (64%). In our opinion esophageal transection with extended gastroesophageal devascularization is an effective method of controlling variceal hemorrhage, with very low recurrence rate and allows to avoid postoperative encephalopathy.