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November 1974

Transthoracoesophageal Ligation of Bleeding Esophageal Varices: A Reappraisal

Author Affiliations

From the departments of surgery (Drs. Wirthlin and Linton) and medicine (Dr. Ellis), Massachusetts General Hospital and the Harvard Medical School, Boston.

Arch Surg. 1974;109(5):688-692. doi:10.1001/archsurg.1974.01360050082018

Transthoracoesophageal ligation of bleeding esophageal varices was carried out in 55 patients with a survival of 71%. All good-risk patients (Child criteria) survived; 75% of moderate-risk patients and 48% of poor-risk patients survived. Nine patients underwent exploratory surgery for recurrent variceal bleeding following a portosystemic shunt, and 46 patients underwent variceal ligation as the first step of a two-stage procedure for the control of bleeding esophageal varices. Sixty-four percent of the latter group had a subsequent portosystemic shunt, usually of the splenorenal type, to avoid encephalopathy and liver failure associated with portacaval shunt. Group A and B patients had 52% cumulative survival at five years and 24% cumulative survival at ten years. Transthoracoesophageal ligation of varices, followed preferably by an end-to-side splenorenal shunt and splenectomy, remains the most satisfactory method for the control of esophageal bleeding secondary to Laënnec cirrhosis.