J.Jpn. Surg. Soc.. 83(9): 856-860, 1982

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Report on the annual meeting

PRESENT STATUS AND PERSPECTIVES OF SURGICAL TREATMENT OF ESOPHAGEAL VARICES

In Japan, selective shunt and direct interruption procedures are preferred ones in the surgical treatment of esophageal varices, and their results are superior to those in America and Europe. On the bases of 4171 patients reported by members of Portal Hypertension Society added with our own cases, I show the present status and problems in the surgical treatment of esophageal varices.
1) With emergent patients, direct interruption may be employed. But, since it is associated with 25.6 percent operative mortality, we should prefer a conservative therapy.
2) Sclerozation or embolization as conservative measures can terminate bleeding frequently. Since rebleeding is not infrequent, however, these measures may be used as adjunct therapy until elective procedure can be done.
3) Endoscopy is very useful in selecting candidates for prophylactic procedure. Thus, patients with blue varices or red color sign are good candidates.
4) As elective and prophylactic procedures, selective shunt or direct interruption should be performed. Operative mortality and rebleeding rate are 5.1 percent and 7.8 percent with the former and 8.8 percent and 6.8 percent with the latter procedure, respectively.
5) Treatment measures for postoperative gastric bleeding or esophageal varices associated with hepatoma will remain as important theme.

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