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Left-upper-quadrant devascularization for 'unshuntable' portal hypertension.

M T Caps·W S Helton·K Johansen
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Abstract

BACKGROUND: No simple solution exists for the patient with bleeding due to diffuse splanchnic venous thrombosis (so-called unshuntable portal hypertension). Radical gastroesophageal devascularization or extended esophagogastrectomy has been considered obligatory in this setting. OBJECTIVE: To examine the use of 1-stage, left-upper-quadrant devascularization for unshuntable portal hypertension. DESIGN: A retrospective call-back survey. SETTING: A regional referral center. PATIENTS: Eight consecutive patients with recurrent bleeding from esophagogastric varices due to diffuse splanchnic venous thrombosis. INTERVENTIONS: Splenectomy, staple transection of the esophagus, and proximal gastric devascularization. MAIN OUTCOME MEASURES: Operative complications, recurrent bleeding, survival, and quality of life. RESULTS: No operative deaths occurred, and 7 of 8 patients who were treated for unshuntable portal hypertension and who were followed-up for 1 to 15 years (mean, 4.7 years) are alive. No patient has had a recurrent variceal hemorrhage. A second endoscopy has demonstrated small varices in 4 patients. Early and late complications occurred in 3 and 1 of the patients, respectively. CONCLUSIONS: Left-upper-quadrant devascularization is a technically straightforward, safe, effective, and durable alternative to the Sugiura procedure or to radical esophagogastrectomy in patients with unshuntable portal hypertension.

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AdultAgedEsophageal and Gastric VaricesEsophagectomyFemaleGastrectomyGastrointestinal HemorrhageHumansHypertension, PortalMaleMiddle AgedRecurrenceRetrospective StudiesSplanchnic CirculationSplenectomyThrombosisTreatment OutcomeJournal Article

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BibTeXRIS

M T Caps, W S Helton, K Johansen. 1996. Left-upper-quadrant devascularization for 'unshuntable' portal hypertension.. https://doi.org/10.1001/archsurg.1996.01430200044008

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