Portasystemic shunt operations provide effective and prolonged control of bleeding from gastroesophageal varices accompanying portal hypertension. In patients who are not candidates for emergency portal decompression because of extrahepatic portal vein obstruction, small size of vein, or other reasons, direct surgical interruption of bleeding esophageal varices may be employed. Transesophageal suture of varices, as advocated by Boerema,1 Crile,2 and Linton and Warren3 controls bleeding immediately but is followed by a high incidence of rebleeding and the risk of leakage from an esophageal suture line. More extensive operations such as gastroesophageal resection4,5 gastric or esophageal transection,6 and portaazygos disconnection,7 reduce the likelihood of recurrent bleeding but require an esophageal anastomosis and may cause gastroesophageal reflux and esophagitis postoperatively. To reduce these hazards, a technique has been devised for transthoracic, transgastric suture of bleeding varices with devascularization and reconstruction of the cardia. This method interrupts submucosal
Skinner DB. Transthoracic, Transgastric Interruption of Bleeding Esophageal Varices. Arch Surg. 1969;99(4):447–453. doi:10.1001/archsurg.1969.01340160027006
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: