Left-upper-quadrant devascularization for 'unshuntable' portal hypertension.

BACKGROUND

No simple solution exists for the patient with bleeding due to diffuse splanchnic venous thrombosis (so-called unshuntable portal hypertension). Radical gastroesophageal devascularization or extended esophagogastrectomy has been considered obligatory in this setting.

OBJECTIVE

To examine the use of 1-stage, left-upper-quadrant devascularization for unshuntable portal hypertension.

DESIGN

A retrospective call-back survey.

SETTING

A regional referral center.

PATIENTS

Eight consecutive patients with recurrent bleeding from esophagogastric varices due to diffuse splanchnic venous thrombosis.

INTERVENTIONS

Splenectomy, staple transection of the esophagus, and proximal gastric devascularization.

MAIN OUTCOME MEASURES

Operative complications, recurrent bleeding, survival, and quality of life.

RESULTS

No operative deaths occurred, and 7 of 8 patients who were treated for unshuntable portal hypertension and who were followed-up for 1 to 15 years (mean, 4.7 years) are alive. No patient has had a recurrent variceal hemorrhage. A second endoscopy has demonstrated small varices in 4 patients. Early and late complications occurred in 3 and 1 of the patients, respectively.

CONCLUSIONS

Left-upper-quadrant devascularization is a technically straightforward, safe, effective, and durable alternative to the Sugiura procedure or to radical esophagogastrectomy in patients with unshuntable portal hypertension.