Should ablative operations be used for bleeding esophageal varices?

To evaluate the long-term success of an ablative procedure for esophageal varices, the clinical results of 60 standardized, non-shunt (Womack) operations performed from 1953-1974 were reviewed. The overall operative mortality in this series was 35%. The 39 patients surviving operation have been followed from 5 to 21 years (mean: 13.3 years). Excluding operative mortality, the absolute 5-year survival rates for Child's classes A, B, and C patients were 100%, 63%, and 33%, respectively. The actuarial survival for all patients was 40% at 5 years, 24% at 10 years, and 15% at 15 years. Although the incidence of recurrent bleeding was 54%, clinical factors predictive for rebleeding could not be identified. A review of a collected series of other ablative operations, with and without esophageal transection, generally reveals unacceptable mortality and rebleeding rates. It is concluded that an ablative operation without esophageal transection should be used only in highly selected patients who do not have appropriate veins suitable for venous shunt.