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November 1974

Transthoracoesophageal Ligation of Bleeding Esophageal VaricesA 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.