[Surgical procedure in acute variceal hemorrhage (author's transl)].

Abstract

The author recommends various general rules to be observed in the surgical treatment of acute variceal hemorrhage: 1. attempts to arrest the hemorrhage by conservative means are always justified in the case of variceal bleeding, but should be comprehensive, and both patient and staff should first be prepared for surgery in case it should become necessary: 2. if when the GI tract is free of blood the indications for surgery are found to be present, a shunt should be constructed at once (Crile's stage A); 3. if hemorrhage starts again after carefully monitored release of the ballons of the Sengstaken-Blakemore tube, conservative measures should be carefully applied again at once. If an experienced endoscopist is available, paravariceal sclerosing injections should be given at this point. Otherwise a shunt operation is indicated (Crile's stage B). In patients in whom liver tolerance is poor (Crile's stage C), transhoracic dissection of the esophageal varices is indicated as the only possible, definitive treatment.