TRANSABDOMINAL ESOPHAGEAL STAPLING FOR CONTROL OF VARICEAL HEMORRHAGE

M Ghnnam, Wagih; E Dawoud, Ibrahim; M Ali, Abd El-Azem; M Shouman, Osama; A Amer, Talal

doi:10.21608/ejsur.2001.375848

TRANSABDOMINAL ESOPHAGEAL STAPLING FOR CONTROL OF VARICEAL HEMORRHAGE

Document Type : Original Article

Authors

¹ Departments of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura ,Egypt.

² Diagnostic Radiology, Mansoura Faculty of Medicine , Mansoura University, Mansoura ,Egypt.

10.21608/ejsur.2001.375848

Abstract

Variceal hemorrhage is the most dramatic presentation of portal hypertension, and its treatment is complex. This study
evaluates the role of different lines of treatment for control of variceal bleeding in patients with portal hypertension.
This study was done on 45 patients with bleeding esophageal varices due to portal hypertension, classified equally into 3
groups. Group I patients treated by splenectomy and devascularisation, Group II patients treated by transabdominal
esophageal stapling combined with splenectomy and devascularisation, and Group III patients treated by sclerotherapy.
Control of bleeding was achieved in patients treated by surgery in Group I and II patients, while recurrent bleeding
occurred in 4 patients in Group III. No mortality was detected in Group I patients, one patient from Group I, and two
patients from Group II died. RBCs and platelet counts significantly increased in Group I and II patients while no significant change was detected in Group III patients.
Esophageal transection and gastric devascularisation appears to have better survival rate, less mortality, lesser
recurrent bleeding and encephalopathy over endoscopic sclerotherapy. A potential disadvantage of extensive upper abdominal surgery is that it may complicate subsequent orthotopic liver transplantation. In economic terms, sclerotherapy was the most cost effective treatment, less hospital stay, less invasive.
We conclude that the sclerotherapy is the treatment of choice in emergency control of variceal bleeding, patients unfit for surgery, recurrent bleeding after surgery, and for Pugh grade C patients. Surgical treatment is a reasonably effective approach when endoscopic sclerotherapy fails or is not indicated in unsuitable patients.

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