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HPB Surgery
Volume 7, Issue 3, Pages 201-209
http://dx.doi.org/10.1155/1994/50485

Management of Isolated Gastric Varices by Devascularization and Proximal Gastrectomy in Cirrhotic Patients

1Department of Surgery, Kaohsiung Medical College, Kaohsiung, Taiwan
2Department of Surgery, Kaohsiung Medical College, 100 Shih-Chuan 1st Road, Kaohsiung, Taiwan

Received 8 February 1993; Accepted 25 April 1993

Copyright © 1994 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Twenty patients with liver cirrhosis were treated by surgery for bleeding from isolated gastric varices. The presence of tortuous and engorged gastric veins connecting with a large splenorenal shunt was demonstrated by transhepatic portography in all patients. The surgical procedures consisted of splenectomy, proximal gastrectomy, paragastric devascularization, and ligation of the splenorenal shunt. Sixteen patients survived the surgery. Four deaths were caused by emergency operation for uncontrollable hemorrhage in extremely poor risk patients. Of the 16 survivors, 15 had been followed wth endoscopy and portography for a mean period of 42 months. The other one died of hepatocellular carcinoma three years after surgery. There was no bleeding episode during the period of follow-up in these patients. Recurrent esophageal varices of mild degree were documented by endoscopy and portography in three patients. Portography demonstrated that several newly formed retroperitoneal veins arising from the junction of the portal and superior mesenteric veins joined to form recurrent varices in these three patients. There was no significant change of the mean portal venous pressure before and after surgery. Our data reveals that elective surgery may provide satisfactory results in patients with isolated gastric varices. Transhepatic portography is the method of choice in radiologic investigation for prominent gastric varices.