The late results of terminal esophagoproximal gastrectomy (TEPG) with intensive devascularization and splenectomy for bleeding esophageal varices in cirrhosis.

The operative procedure of terminal esophagoproximal gastrectomy (TEPG) with extensive esophagogastric devascularization and splenectomy is described in detail and its rationale is discussed. Late results of this operation performed therapeutically on 64 patients with posthepatitic cirrhosis revealed that (1) operative mortality rate (death within a month) was 11%, mostly being contributed by poor-risk patients; (2) over-all survival was 65% at 5 years and 59% at 10 years; (3) gastrointestinal bleeding recurred in nine patients, five of whom had major and four minor hemorrhages; (4) portasystemic encephalopathy was seen frequently after shunts had never occurred, and the hepatic encephalopathy was only a sequel of major gastrointestinal bleeding or a manifestation of terminal-stage liver insufficiency; and (5) ascites was not a major clinical problem after this operation; mild esophagitis was an occasional complication.