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KMID : 0371320010610040400
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Journal of the Korean Surgical Society
2001 Volume.61 No. 4 p.400 ~ p.405
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Perigastric Devascularization with or without Fundectomy for Gastric Variceal Bleeding
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Yi Nam-Joon
Han Ho-Seong
Kim Young-Woo
Min Seog-Ki
Choi Yong-Man
Yi Sun-Young
Yoo Kwon
Lee Han-Chu
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Abstract
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Purpose : Catastrophic bleeding of the gastric varices has been considered a life threatening emergency. Sclerotherapy cannot easily control the bleeding, and there is a high risk of rebleeding despite successful intervention. Surgery is
often
necessary to save the life. The purpose of this study was to elucidate the role of surgery and analyze the factors determining operative mortality in gastric variceal bleeding.
Methods : A retrospective study was performed of 30 patients who underwent operation for gastric variceal bleeding with portal hypertension at Ewha Womans University Mok-Dong Hospital from Jul. 1994 to Feb. 2001. Among them, 23 patients
received
perigastric devascularization with fundectomy and the remainder received perigastric devascularization alone.
Results : There was one case of recurrent bleeding from esophageal varix at 8 months postoperative. This was controlled with sclerotherapy. The overall operative mortality rate was 30.0%. Preoperative hepatic functional reserve was a
significant
factor. The mortality rate was 0% (0/5) in Child-Pugh group A, 27.8% (5/18) in group B, and 57.1% (4/7) in group C (p<0.05). The preoperative success of intervention influenced postoperative outcomes. There was no mortality in the successfully
controlled group (0/5). In the failure group, 5 of 7 patients expired (p<0.05). Preoperative transfusion amount was also a significant factor in determining survival. There was 15.8% (3/19) mortality rate in patients trans fused less than 10
units,
and
a 54.5% (6/11) rate in those receiving more than 10 units (p<0.05).
Conclusion : This operative approach was effective for saving lives from an otherwise uniformly fatal disease. The rebleeding rate at the follow-up period was low. Proper selection of patients and an early surgical decision could lower the
operative mortality.
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KEYWORD
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