REVIEW ON THE CAUSES OF RE-BLEEDING AFTER DIRECT SURGICAL INTERVENTION FOR ESOPHAGEAL VARICES

Abstract

The causes and the mechanism of re-bleeding after direct surgical intervention of esophageal varices were reviewed. Two hundreds and five patients with esophageal varices were treated by direct surgical intervention. One hundred and forty-five patients underwent terminal esophagoproximal gastrectomy (TEPG) involving extensive esophagogastric devascularization and splenectomy fifty-eight underwent proximal gastric transection (PGT) and 2 underwent total gastrectomy. We encountered 20 postoperative re-bleeding. The rates of re-bleeding from each operation mentioned above were 7.6, 13.8, and 50%, respectively. The rates of re-bleeding from the causes of portal hypertension were 38.5% in extrahepatic portal obstruction (EPO), 2.7% in intrahepatic portal obstruction (IPO-fibrosis) and 9.0% in liver cirrhosis (IHO). When re-bleeding occurred, we found (1) advancing hepatic damages, (2) development of new hepatofugal collateral veins from the portal trunk and/or splenic vein by portography, and (3) change of portal hemodynamic circulation from IHO to EPO in almost half of the cases.
Re-bleeding after direct surgical intervention can be considered to be predistined, since it does not decompress the portal vein pressure. The results of the present study showed that the re-bleeding rate was the lowest after TEPG, indicating that theis surgical procedure is the most acceptable one for the control of variceal bleeding.