Transabdominal Gastro‐esophageal Devascularization and Esophageal Transection for Bleeding Esophageal Varices after Failed Injection Sclerotherapy: Long‐Term Follow‐Up Report

• Published in: World journal of surgery 2006-07, Vol.30 (7), p.1329-1337
• Main Authors: Qazi, Shabir Ahmad, Khalid, Kamran, Hameed, Abdul Majeed Abdul, Al‐Wahabi, Khalid, Galul, Radwan, Al‐Salamah, Saleh M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Contrast Media; Diatrizoate Meglumine; Esophageal and Gastric Varices - surgery; Esophageal and Gastric Varices - therapy; Esophageal Varix; Esophagus - blood supply; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - surgery; Gastrointestinal Hemorrhage - therapy; Humans; Male; Middle Aged; Portal Hypertension; Prospective Studies; Recurrence; Recurrent Bleeding; Sclerotherapy - methods; Stomach - blood supply; Survival Rate; Transjugular Intrahepatic Portosystemic Shunt; Treatment Failure; Treatment Outcome; Variceal Bleeding
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-005-0372-7

Background Management of continued bleeding from esophageal varices despite adequate injection sclerotherapy remains one of the medical and surgical dilemmas. Transabdominal gastroesophageal devascularization and esophageal transection (TGDET) is considered an effective and safe procedure for such patients. Aim This study aimed at presenting continued evaluation of TGDET. Various problems influencing the early outcome are discussed, and long‐term outcome is analyzed. Design This was a prospective clinical descriptive study. Methods Prospective data was collected on 142 consecutive patients managed by one group of surgeons over a 5 year‐period and 15 years follow‐up after failed injection sclerotherapy for variceal bleeding. Evaluation was made in terms of effectiveness in controlling the acute bleeding, postoperative morbidity and mortality, recurrent bleeding, encephalopathy, and long‐term survival. Results There were 133 men and 9 women. Mean age was 41.8 years. Etiology of portal hypertension was bilharziasis in 54.9% and posthepatitic in 14.8%. Child–Pugh grading on admission was A: 47.2%, B: 28.8%, and C: 14%. Hemorrhage was controlled in all cases. Clinical leak was observed in 5.6%, portal vein thrombosis in 6.3%, and staple line erosion in 2.1% of cases. No patient developed encephalopathy. In‐hospital mortality was 12.7%. Complete eradication of varices was observed in 70.6% patients. Recurrent variceal bleeding was noticed in 6.9% of cases. Actuarial 15‐year survival for Child–Pugh A patients was 44%, B was 22.5%, and none for C. Conclusion TGDET remains a safe and effective procedure after failure of sclerotherapy when other alternatives are either not indicated or not available.