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August 1969

Treatment of Bleeding Esophageal Varices in Portal-Systemic Shunt Failures: By Extensive Gastrectomy, Esophagogastrectomy, or Total Esophagectomy

Author Affiliations

From the Department of Surgery, University of Minnesota Medical School, Minneapolis. Dr. Bernstein is now at the University of California at San Diego, LaJolla.

Arch Surg. 1969;99(2):171-178. doi:10.1001/archsurg.1969.01340140043007

In some patients with massive hemorrhage from esophageal varices, and particularly in extrahepatic portal obstruction, shunting procedures fail to prevent further significant bleeding or are technically impossible. For this relatively small group of patients with portal hypertension, a variety of approaches have been proposed, including varix ligation,1 hepatic or splenic arterial ligation,2 injection of sclerosing agents,3 omentopexy,4 mediastinal packing,5 gastric and esophageal transection and resuture,6-8 and gastric and esophageal resection. These latter operations have been designed either to excise the acid-secreting portions of the stomach and thereby prevent acidpeptic erosion of the mucosal covering of the varices, or to excise the varix tissue itself.

The introduction of procedures involving excision of the stomach and esophagus occurred during the same years that the potral-systemic shunt procedures were first clinically introduced on a broad scale (Table 1).9-14 However, the number of patients subjected to such

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