J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 2512KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 93(9): 1164-1168, 1992

Report on the annual meeting

THE CURRENT ROLE OF DEVASCULARIZATION AND TRANSECTION PROCEDURES IN PORTAL HYPERTENSION

Second Department of Surgery, University of Tokyo, Faculty of Medicine, Tokyo, Japan

Kensho Sanjo, Hiroaki Imanishi, Hiroshi Imamura, Yasushi Harihara, Yasutsugu Bandai, Yasuo Idezuki

It is not clear which theory should be used in patients with bleeding esophageal varices that are not controlled by emergency endoscopic sclerotherapy. Definitive hemostasis is the key to successful therapy of variceal bleeding. Recurrence of haemorrhage in patients with portal hypertension is the most feared lifethreatening complication.
Based on our management of 658 patients with esophageal varices and the availability of treatment options at our institution, the strategy of management of uncontrollable variceal haemorrhage by endoscopic sclerotherapy has evolved.
Bleeding was controlled in 64 liver cirrhosis (100%) by devascularization and transection procedures and 50 patients (78%) survived to leave the hospital including 43 of 64 patients (67%) with Child grade C liver cirrhosis. Cumulative rebleeding rate at 10 years following emergency surgery was 3% (2/64). It is associated with a lower morbidity and mortality as well as a lower incidence of subsequent encephalopathy. We suggest that emergency transection and devascularization is an effective salvage treatment for the endoscopic sclerotherapy failed group.

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