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.
Conclusion:
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.Arch Surg. 1996;131:834-839