Transabdominal gastroesophageal devascularization without transection for bleeding varices: results and indicators of prognosis.

BACKGROUND

Esophagogastric devascularization is an operation that can be performed for endoscopically uncontrolled variceal bleeding in hospitals having only basic surgical instruments and is therefore an appropriate procedure for small hospitals in developing countries. The aim of this study was to analyze one hospital's experience of this operation in consecutive patients with variceal bleeding.

METHODS

Between 1996 and 2003, 45 patients (30 male, 15 female) who had a mean age of 40 years (range 7-78 years) underwent devascularization procedures. Of the 45, 23 had cirrhosis and 22 had non-cirrhotic portal hypertension (11 extrahepatic portal venous obstruction, 11 non-cirrhotic portal fibrosis), and 18 patients had emergency procedures and 27 were elective. Mortality, morbidity, rebleeding rates and the prognostic factors for death were assessed.

RESULTS

Elective and emergency mortality was one (3.7%) and 11 (61%) patients, respectively. There was no rebleeding in hospital. At follow up (mean 48 months, range 3-92 months) overall survival in patients with cirrhosis was 7 out of 20 and in patients with non-cirrhotic portal hypertension was 19 of 21. Five (17%) had recurrent variceal hemorrhage, of whom three, all cirrhotic patients, died. Preoperative prognostic indicators for death were emergency surgery, a Child-Pugh score >or=10, preoperative blood transfusion >or=20 units and renal failure.

CONCLUSIONS

Gastroesophageal devascularization effectively controls variceal bleeding especially in non-cirrhotic patients with portal hypertension. In the elective situation it carries a low mortality and rebleed rate. In emergencies the prognosis is poor with advanced cirrhosis, following large quantities of blood transfusion and deranged renal function. It is suggested that this operation be offered especially to non-cirrhotic patients in hospitals in developing countries where facilities for more sophisticated procedures are not available.