April 1984

Mortality and Rebleeding After Hypertensive Variceal Disconnections

Author Affiliations

From the Surgical Service, Wood (Wis) Veterans Administration Medical Center and the Department of Surgery, Medical College of Wisconsin, Milwaukee.

Arch Surg. 1984;119(4):446-449. doi:10.1001/archsurg.1984.01390160076015

• Forty-five patients had operative disconnections of portoazygos venous collaterals for variceal hemorrhage. Nineteen alcoholic patients had urgent partial azygos disconnection (PAD) to control bleeding; this involved intragastric variceal and coronary and distal gastric-vein ligation. A complete azygos disconnection (CAD), which also included splenectomy, was done urgently in 14 patients and electively in 12 patients; 15 were alcoholics. All patients were assessed for operative risk by a modified Child's classification. Hospital mortality after urgent PAD or CAD in alcoholics was 67%, largely due to intraperitoneal sepsis or hepatorenal failure with recurrent hemorrhage. Operative modified Child's classification of survivors was better (lower) than in nonsurvivors. Eleven nonalcoholic patients had CAD; two died of intraperitoneal sepsis. Nine survivors did not rebleed nor have encephalopathy develop during an average follow-up of 41 months. Complete azygos disconnection was a good alternative, particularly in the elective setting, for patients with nonalcoholic portal hypertension.

(Arch Surg 1984;119:446-449)