Perigastric Devascularization with or without Fundectomy for Gastric Variceal Bleeding.
- Author:
Nam Joon YI
1
;
Ho Seong HAN
;
Young Woo KIM
;
Seog Ki MIN
;
Yong Man CHOI
;
Sun Young YI
;
Kwon YU
;
Han Chu LEE
Author Information
1. Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea. hanhs@mm.ewha.ac.kr
- Publication Type:Original Article
- Keywords:
Gastric varix;
Fundal varix;
Hassab's operation;
Perigastric devascularization;
Fundectomy
- MeSH:
Emergencies;
Esophageal and Gastric Varices*;
Female;
Follow-Up Studies;
Hemorrhage;
Humans;
Hypertension, Portal;
Mortality;
Retrospective Studies;
Sclerotherapy
- From:Journal of the Korean Surgical Society
2001;61(4):400-405
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
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.
