Seventy-five patients with esophageal varices underwent different types of non-shunting operations from March 1978 through March 1989. The procedures in included 61 transabdominal esophageal transection(Kobayashi), 8 esophageal transection with
paraesophagogastric devascularization(Sugiura), 5 gastroesophageal decongestion and splenectomy(Hassab), and one esophageal transection without devascularization. The ages of the patients ranged from 14 years to 68 years. Of 75) patients, 58 were
male.
Nine of the patients were Child's Class A, 36 were Class B, and 30 were Class C. Portal hypertension was secondary to liver cirrhosis in 70 patients, to idiopathic portal hypertension in 3, to congenital hepatic fibrosis in one, and to pancreatic
cystadenoma in one.
Fourteen operations were performed in an emergency setting and 56 were undertaken electively. Five patients with a marked hypersplenism and a high degree of red-color sign on esophagoscopy was subjected to a prophylactic surgery. Nine patients in
this
series had prior endoscopic injection sclerotherapy. There were two hospital deaths(2.7%). Four cases(5.3%) had recurrent bleeding, which responded promptly to a conservative and endsocpic sclerotherapies. None of the patients developed
encephalopathy
subsequent to the operation. Post-transection esophageal stricture was noted in 6 cases. The condition, however, was easily amenable to conservative measures. There were 11 cases of late mortality, 3 from co-existing hepatoma, 2 from
cardiovascular
accident, and 6 from terminal liver failure. The overall cumulative survival rate was 82.0% at five years surgery.
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