Prevention of Recurrent Bleeding: Nonshunt Surgery

  • Roy A. J. Spence


The management of patients with bleeding esophageal and gastric varices remains a challenging area. The standard management of clinical and laboratory assessment is well established and various indicators of prognosis are now being established [1], Child’s classification and Pugh’s modification have been well accepted [2,3] and more recently further attempts to predict outcome of bleeding have been published from Glasgow [4] and the Middle East [5]. In the Glasgow study prothrombin ratio, serum creatinine, and the presence of encephalopathy were shown to have independent prognostic significance, whereas in the Middle East study the prothrombin ratio was shown to be the most important indicator.


Portal Hypertension Esophageal Varix Gastric Varix Oesophageal Varix Portacaval Shunt 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Burroughs AK (1987) Variceal haemorrhage. In: Misiewicz JJ, Pounder RE, Venables CW (eds) Diseases of the gut and pancreas. Blackwell, London pp 439–441Google Scholar
  2. 2.
    Child CG, III, Turcotte JG (1964) Surgery and portal hypertension. In: Child CG (ed) The liver and portal hypertension. WB Saunders, Philadelphia, p 50Google Scholar
  3. 3.
    Pugh RNH, Murray-Lyon IM, Dawson JL (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60: 646–649PubMedGoogle Scholar
  4. 4.
    Garden OJ, Motyl H, Gilmour WH, Utley RJ, Carter DC (1985) Prediction of outcome following acute variceal haemorrhage. Br J Surg 72: 91–95PubMedGoogle Scholar
  5. 5.
    Jacobs S, Chang RWS, Lee B, Rawaf A AL, Pace NC, Salam I (1989) Prediction of outcome in patients with acute variceal haemorrhage. Br J Surg 76: 123–126PubMedGoogle Scholar
  6. 6.
    Burroughs AK, McCormick PA (1989) Management of variceal bleeding. In: Davis M (ed) Therapy of liver disease. Clinical gastroenterology. Balliere, Saunders London, pp 133–134Google Scholar
  7. 7.
    Smith JL, Graham DY (1982) Variceal haemorrhage, a critical evaluation of survival analysis. Gastroenterology 82: 968–972PubMedGoogle Scholar
  8. 8.
    Graham DY, Smith JL (1981) The course of patients after variceal hemorrhage. Gastroenterology 80: 800–809PubMedGoogle Scholar
  9. 9.
    McCormick PA, Mezzanotte G, Phillips A, McIntyre N, Burroughs AK (1988) Variceal bleeding, importance of the time interval between admission and starting point for analysis of survival and rebleeding. Gut 29: A719Google Scholar
  10. 10.
    Terblanche J, Burroughs AK, Hobbs KEF (1989) Controversies in the management of bleeding esophageal varices. New Engl J Med 320: 1393–1398PubMedGoogle Scholar
  11. 11.
    Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M (1985) Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5: 419–424PubMedGoogle Scholar
  12. 12.
    Staritz M, Poralla T, Meier zum Büschenfelde KH (1985) Intravascular oesophageal variceal pressure assessed by endoscopic fine needle puncture under basal conditions, Valsalva’s manoeuvre and after glycery/trinitate application. Gut 26: 525–530PubMedGoogle Scholar
  13. 13.
    Kleber G, Sauerbruch T, Fischer G, Paumgartner G (1988) Somatostatin does not reduce oesophageal variceal pressure in liver cirrhotics. Gut 29: 153–156PubMedGoogle Scholar
  14. 14.
    Kleber G, Sauerbruch T, Fischer G, Paumgartner G (1989) Pressure of intra-oesophageal varices assessed by fine needle puncture: Its relation to endoscopic signs and severity of liver disease in patients with cirrhosis. Gut 30: 228–232PubMedGoogle Scholar
  15. 15.
    Baker LA, Smith C, Lieberman G (1959) The natural history of esophageal varices. Am J Med 26: 228–237PubMedGoogle Scholar
  16. 16.
    Pagliaro L, D’Amico G, Maringhini A (1980) History of non-alcoholic cirrhosis in medical and surgical problems of portal hypertension. In: Orloff MJ, Stipa S, Ziparo U (eds) Serono Symposium (34). Academic, London, pp 109–117Google Scholar
  17. 17.
    Lebrec D, DeFleury P, Rueff B, Nahum H, Benhamou J-P (1980) Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 79: 1139–1144PubMedGoogle Scholar
  18. 18.
    Burroughs AK, D’Heygere F, McIntyre N (1986) Pitfalls in studies of prophylactic therapy for variceal bleeding in cirrhotics. Hepatology 6: 1407–1413PubMedGoogle Scholar
  19. 19.
    Dagradi AE (1972) The natural history of esophageal varices in patients with alcoholic liver cirrhosis. Am J Gastroenterol 57: 520–540PubMedGoogle Scholar
  20. 20.
    Paquet KJ (1981) Prophylactic endoscopic sclerosing treatment of oesophageal wall in varices—a prospective controlled randomised trial. Endoscopy 27: 213–218Google Scholar
  21. 21.
    Beppu K, Inokuchi K, Koyanagi N (1981) Prediction of variceal haemorrhage by esophageal endoscopy. Gastroenterol Endosc 27: 213–218Google Scholar
  22. 22.
    Inokuchi K and Cooperative Study Group of Portal Hypertension of Japan (1984) Prophylactic portal non-decompression surgery in patients with esophageal varices. Ann Surg 200: 61–65PubMedGoogle Scholar
  23. 23.
    The North Italian Endoscopic Club (1988) Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. New Engl J Med 319: 983–9Google Scholar
  24. 24.
    Merigan TC, Poltkin GR, Davidson CS (1962) Effect of intravenously administered posterior pituitary extract on hemorrhage from bleeding esophageal varices. New Engl J Med 266: 134–135PubMedGoogle Scholar
  25. 25.
    Fogel MR, Knaver M, Andrew LL (1982) Continuous intravenous vasopressin in active upper gastrointestinal bleeding. Ann Int Med 96: 565–569PubMedGoogle Scholar
  26. 26.
    Conn HO, Ramsby GR, Storer EH (1975) Intra-arterial vasopressin in the treatment of upper gastrointestinal hemorrhage—a prospective controlled clinical trial. Gastroenterology 68: 211–221PubMedGoogle Scholar
  27. 27.
    Freeman JG, Lishman AH, Cobden I, Record CO (1982) Controlled trial of Terlipressin (glypressin) versus vasopressin in the early treatment of oesophageal varices. Lancet II: 66–68Google Scholar
  28. 28.
    Kravetz I. Bosch J, Teres J (1984) Comparison of intravenous somatostatin and vasopressin infusions in the treatment of acute variceal hemorrhage. Hepatology 4: 422–426Google Scholar
  29. 29.
    Jenkins SA, Baxter JN, Corbett WA, DeVitt P, Ware J, Shields R (1985) A prospective randomised controlled clinical trial comparing somatostatin and vasopressin in controlling acute variceal haemorrhage. Br Med J 290: 1275–1278Google Scholar
  30. 30.
    Gimson AES, Westaby D, Hegarty J, Watson A, Williams R (1986) A randomized trial of vasopressin and vasopressin plus nitroglycerine in the control of acute variceal hemorrhage. Hepatology 6: 410–413PubMedGoogle Scholar
  31. 31.
    Mitchell K, Silk DA, Williams R (1980) Prospective comparison two Sengstaken tubes in the management of patients with variceal haemorrhage. Gut 21: 570–573PubMedGoogle Scholar
  32. 32.
    Hosking SW, Doss W, El-Zeing H, Robinson P, Barsoum MS, Johnson AG (1988) Pharmacological constriction of the lower oesophageal sphincter—a simple method of arresting variceal haemorrhage Gut 29: 1098–1102PubMedGoogle Scholar
  33. 33.
    Barsoum MS, Boulos FI, El-Rooby AA (1982) Tamponade and injection sclerotherapy in the management of bleeding oesophageal varices. Br J Surg 69: 76–78PubMedGoogle Scholar
  34. 34.
    Paquet KJ, Feussner H (1985) Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices a prospective controlled randomized trial. Hepatology 5: 580–583PubMedGoogle Scholar
  35. 35.
    Larson AW, Cohen H, Zweiban B (1986) Acute esophageal variceal sclerotherapy. JAMA 255: 497–500PubMedGoogle Scholar
  36. 36.
    Copenhagen Esophageal Varices Sclerotherapy Project (1984) Sclerotherapy after first variceal hemorrhage in cirrhosis. New Engl J Med 311: 1584–1600Google Scholar
  37. 37.
    Bornman PC, Terblanche J, Kahn D (1986) Limitations of multiple injection sclerotherapy sessions for acute variceal bleeding. S Afr Med J 70: 34–36PubMedGoogle Scholar
  38. 38.
    Teres J, Baroni R, Bordas JM, Vias J, Pera C, Rodes J (1987) Randomised trial of portacaval shunt stapling transection and endoscopie sclerotherapy in uncontrolled variceal bleeding. J Hepatol 4: 159–167PubMedGoogle Scholar
  39. 39.
    Cello JP, Grendell JH, Grass RA (1987) Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and acute variceal hemorrhage. Long-term follow-up. New Engl J Med 316: 11–15PubMedGoogle Scholar
  40. 40.
    Orloff MJ, Bell RH, Greenbury AG (1986) Prospective randomised trial of emergency portacaval shunt and medical therapy in unselected cirrhotic patients with bleeding varices (abstract). Gastroenterology 90: 1974Google Scholar
  41. 41.
    Lacaine F, LaMuraglia GM, Malt RA (1985) Prognostic factors in survival after portasystemic shunts: Multivariate analysis. Ann Surg 202: 729–734PubMedGoogle Scholar
  42. 42.
    Jackson FC, Perrin EB, Felix R (1971) A clinical investigation of the portacaval shunt v. survival analysis of the therapeutic operation. Ann Surg 174: 672–701PubMedGoogle Scholar
  43. 43.
    Resnick RH, Iber FL, Ishihara AM (1974) A controlled study of the therapeutic portacaval shunt. Gastroenterology. 67: 843–857PubMedGoogle Scholar
  44. 44.
    Rueff B, Prandi D, Degos F, Degos JD, Maillard JN, Prandi D, Sicot J, Sicot C, Fauvert R, Benhamou JP (1976) A controlled study of therapeutic portacaval shunt in alcoholic cirrhosis. Lancet I: 655–659Google Scholar
  45. 45.
    Reynolds TB, Donovan AJ, Mikkelsen WP, Redekes AG, Turrill FL, Wyener JM (1981) Result of a twelve year randomised trial portacaval shunt patients with alcoholic liver disease and bleeding varices. Gastroenterology 80: 1005–1011PubMedGoogle Scholar
  46. 46.
    Reichle FA, Fahmy WF, Golsorkhi M (1979) Prospective comparative clinical trial with distal splenorenal and portacaval shunts. Am J Surg 137: 13–21PubMedGoogle Scholar
  47. 47.
    Conn HO, Resnick RH, Grace ND, Atterbury CE, Horst D, Groszmann RJ, Gazmuri P, Gusberg RJ, Thayer B, Berk D, Wright SC, Vollman R, Tilson DM, McDermott WV, Cohen JA, Kerstein M, Toole AL, Maselli JP, Razvi S, Ishihara A, Stern H, Trey C, O’Hara ET, Widrich W, Aisenberg H, Stansel HC, Zinny M (1981) Distal splenorenal shunt versus porta-systemic shunt: Current status of a controlled trial. Hepatology 1: 151–160PubMedGoogle Scholar
  48. 48.
    Fischer JE, Bower RH, Atamian S, Welling R (1981) Comparison of distal and proximal splenorenal shunts. A randomized prospective controlled trial. Ann Surg 194: 531–544PubMedGoogle Scholar
  49. 49.
    Langer B, Taylor BR, Mackenzie DR, Gilas T, Stone RM, Blendis L (1985) Further report of a prospective randomized trial comparing distal splenorenal shunt with end-to-side portacaval shunt. An analysis of encephalopathy, survival and quality of life. Gastroenterology 88: 424–429PubMedGoogle Scholar
  50. 50.
    Millikan WJ, Warren WD, Henderson JM, Smith RB III, Salam AA (1985) The Emory prospective randomized trial: Selective versus non-selective shunt to control variceal bleeding. Ten year follow-up. Ann Surg 201: 712–722PubMedGoogle Scholar
  51. 51.
    Harley HAJ, Morgan T, Redeker AG, Reynolds TB, Villamil F, Weiner JM, Yellin A (1986) Results of a randomized trial of end to side portacaval shunt and distal splenorenal shunt in alcoholic liver disease with variceal bleeding. Gastroenterology 91: 802–809PubMedGoogle Scholar
  52. 52.
    Warren WD, Millikan WJ, III Henderson JM, Abu-Elmagd KM, Galloway JR, Shires GT III, Richards WO, Salam AA, Kutner MH (1986) Splenorenal disconnection—improved selectivity of distal splenorenal shunt. Ann Surg 204: 346–355PubMedGoogle Scholar
  53. 53.
    Terblanche J, Bornman PC, Kahn D, Jonker MA, Campbell JA, Wright J, Kirsch R (1983) Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. Lancet II: 1328–1332Google Scholar
  54. 54.
    Korula J, Balart LA, Radvan G, Zweiban BE, Larson AW, Kao HW, Yamada S (1985) A prospective randomized controlled trial of chronic esophageal variceal sclerotherapy. Hepatology 5: 584–589PubMedGoogle Scholar
  55. 55.
    Soderlund C, Ihre T (1985) Endoscopic sclerotherapy vs conservative management of bleeding oesophageal varices. Acta Chir Scand 151: 449–456PubMedGoogle Scholar
  56. 56.
    Westaby D, Macdougall BRD, Williams R (1985) Improved survival following injection sclerotherapy for esophageal varices: Final analysis of a controlled trial. Hepatology 5: 827–830PubMedGoogle Scholar
  57. 57.
    Lebrec D, Poynard T, Bervau J, Bercoff E, Nouel O, Capron JP, Poupon R, Bouvry M, Rueff B, Benhamou JP (1984) A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patient with cirrhosis —a final report. Hepatology 4: 355–358PubMedGoogle Scholar
  58. 58.
    Burroughs AK, Jenkins WJ, Sherlock S, Dunk A, Walt RP, Osuafor TO, Mackie S, Dick R (1983) Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis. New Engl J Med 309: 1539–1542PubMedGoogle Scholar
  59. 59.
    Villeneuve JP, Pomier-Layrarques G, Infante-Rivard C, Willems B, Huet PM, Marleau D, Viallet A (1986) Propranolol for the prevention of recurrent variceal hemorrhage—a controlled trial. Hepatology 6: 1239–1243PubMedGoogle Scholar
  60. 60.
    Marbet UA, Straumann A, Gyr KE, Belinger C, Schauv N, Vogtlin J, Loosli J, Kiowski W, Ritz R, Stalder GA (1980) Reduction in early recurrence of variceal bleeding by propranolol. Scand J Gastroenterol 23: 369–374Google Scholar
  61. 61.
    Jensen LS, Krarup N (1989) Propranolol in prevention of rebleeding from oseophageal varices during the course of endoscopie sclerotherapy. Scand J Gastroenterol 24: 339–45PubMedGoogle Scholar
  62. 62.
    Fleig WE, Stange EF, Hunecke R, Schonborn W, Hurler U, Rainer K, Gaus W, Ditschuneit H (1987) Prevention of recurrent bleeding in cirrhotics with recent variceal hemorrhage: prospective randomized comparison of propranolol and sclerotherapy. Hepatology 7: 355–361PubMedGoogle Scholar
  63. 63.
    Alexandrino PT, Alves MM, Correia JP (1988) Propranolol or endoscopic sclerotherapy in the prevention of recurrence of variceal bleeding. J Hepatol 7: 175–185PubMedGoogle Scholar
  64. 64.
    Sheen IS, Chen JY, Liaw YF (1989) Randomised controlled study of propranolol for prevention of recurrent esophageal varices bleeding in patients with cirrhosis. Liver 9: 1–5PubMedGoogle Scholar
  65. 65.
    O’Connor KW, Lehman G, Yune H, Brunelle R, Christians P, Haste J, Compton M, Lui A, Snodgrass P, Weddle R, Crabb D, Lumeng L, McHenry R, Klapte E, Cockerill E, Holden R, Becker G, Kopecky K, Hawes R, Pound D, Rex D (1989) Comparison of three non-surgical treatments for bleeding esophageal varices. Gastroenterology 96: 899–906PubMedGoogle Scholar
  66. 66.
    Hall RJ, Lilly JR, V-Stiegmann G (1988) Endoscopic esophageal varix ligation: Technique and preliminary results in children. J Pediatr Surg 23: 1222–1223PubMedGoogle Scholar
  67. 67.
    Chiles NH, Baggenstoss AH, Butt HR, Olsen AM (1953) Esophageal varices comparative incidence of ulceration and spontaneous rupture as a cause of fatal hemorrhage. Gastroenterology 25: 565–573PubMedGoogle Scholar
  68. 68.
    Orloff MJ, Thomas HS (1963) Pathogenesis of esophageal varix rupture. A study based on gross and microscopic examination of the esophagus at the time of bleeding. Arch Surg 87: 301–307PubMedGoogle Scholar
  69. 69.
    Dagradi AE, Arguello JF, Weingarten ZG (1979) Failure of endoscopy to establish a source of upper gastrointestinal bleeding. Am J Gastroenterol 72: 395–402PubMedGoogle Scholar
  70. 70.
    Paquet KJ, Oberhammer E (1978) Sclerotherapy of bleeding varices by means of endoscopy. Endoscopy 10: 7–12PubMedGoogle Scholar
  71. 71.
    Terblanche J (1981) Treatment of oesophageal varices by injection sclerotherapy. In: MacLean LD (ed) Advances in surgery Vol 15, Year Book, London, pp 257-291Google Scholar
  72. 72.
    Spence RAJ, Sloan JM, Johnston GW (1983) Oesophagitis in patients undergoing oesophageal transection for varices—a histological study. Br J Surg 70: 332–334PubMedGoogle Scholar
  73. 73.
    Spence RAJ, Sloan JM, Johnston GW (1984) Histologic factors of the oesophageal transection ring as clues to the pathogenesis of bleeding varices. Surg Gynecol Obstet 159: 253–259PubMedGoogle Scholar
  74. 74.
    Spence RAJ (1984) The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: An image analysis study. Br J Surg 71: 739–744PubMedGoogle Scholar
  75. 75.
    Kitano S, Terblanche J, Kahn D, Bornman PC (1986) Venous anatomy of the lower oesophagus in portal-hypertension: practical implications. Br J Surg 73: 525–531PubMedGoogle Scholar
  76. 76.
    Vianna A, Hayes PC, Moscoso G, Driver M, Portmann B, Westaby D, Williams R (1987) Normal venous circulation of the gastro-esophageal junction. Gastroenterology 93: 876–889PubMedGoogle Scholar
  77. 77.
    Noda T (1984) Angioarchitectural study of esophageal varices. Virch Arch 404: 381–392Google Scholar
  78. 78.
    Hashizume M, Kitano S, Sugimachi K, Sueishi K (1988) Three dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology 8: 1482–1487PubMedGoogle Scholar
  79. 79.
    McCormack TT, Rose JD, Smith PM, Johnson AG (1985) Perforating veins and blood flow in oesophageal varices. Lancet II: 1442–1444Google Scholar
  80. 80.
    Walters W, Rowntree LG, McIndoe AH (1929) Ligation of the coronary veins for bleeding esophageal varices. Proc Staff Meet Mayo Clin 4: 146Google Scholar
  81. 81.
    Phemister DB, Humphreys EM (1947) Gastroesophageal resection and total gastrectomy in the treatment of bleeding varicose veins in Banti’s syndrome. Ann Surg 126: 397–410Google Scholar
  82. 82.
    Schafer PW, Kittle CF (1950) Partial esophagogastrectomy in treatment of esophagogastric varices. Arch Surg 61: 235–243PubMedGoogle Scholar
  83. 83.
    Sheline GE, Clark DE, Adams WE, Phemister DB (1951) Symposium on gastrooesophageal surgery, partial gastroesophagectomy for esophageal varices. Surg Clin North Am 31: 213–227PubMedGoogle Scholar
  84. 84.
    Boerema I (1949) Bleeding varices in the oesophagus in cirrhosis of the liver and Banti’s syndrome. Arch Chir Neerl 1: 253–260PubMedGoogle Scholar
  85. 85.
    Crile G (1950) Transesophageal ligation of bleeding esophageal varices: preliminary report of 7 cases. Arch Surg 61: 654–660Google Scholar
  86. 86.
    Linton RR, Warren R (1953) The emergency treatment of massive bleeding from esophageal varices by transesophageal suture of these vessels at the time of acute hemorrhage. Surgery 33: 243–255PubMedGoogle Scholar
  87. 87.
    Orloff MJ (1962) A comparative study of emergency transesophageal ligation and non-surgical treatment of bleeding esophageal varices in unselected patients with cirrhosis. Surgery 52: 103–116PubMedGoogle Scholar
  88. 88.
    Tanner NC (1961) The late results of porto-azygos disconnection in the treatment of bleeding from oesophageal varices. Ann R Coll Surg Engl 28: 153–174PubMedGoogle Scholar
  89. 89.
    Walker RM (1964) Esophageal transection for bleeding varices. Surg Gynecol Obstet 118: 323–329PubMedGoogle Scholar
  90. 90.
    Skinner DB (1969) Transthoracic, transgastric interruption of bleeding esophageal varices. Arch Surg 99: 447–453PubMedGoogle Scholar
  91. 91.
    Hassab MA (1967) Non-shunt operations in portal hypertension without cirrhosis. Surg Gynecol Obstet 131: 648–654Google Scholar
  92. 92.
    Hassab MA (1967) Gastroesophageal decongestion and splenectomy in the treatment of esophageal varices in bilharzial cirrhosis. Further studies with a report on 355 operations. Surgery 61: 169–176PubMedGoogle Scholar
  93. 93.
    Boerema I, Klopper PJ, Holscher AA (1970) Transabdominal ligation—resection of the esophagus in cases of bleeding esophageal varices. Surgery 67: 409–413PubMedGoogle Scholar
  94. 94.
    Johnston GW, Kelly JM (1976) Early experience with the Boerema button for bleeding oesophageal varices. Br J Surg 63: 117–121PubMedGoogle Scholar
  95. 95.
    Sugiura M, Futagawa S (1973) A new technique for treating esophageal varices. J Thorac Cardiovasc Surg 66: 677–685PubMedGoogle Scholar
  96. 96.
    Sugiura M, Futagawa S (1977) Further evaluation of the Sugiura procedure in the treatment of esophageal varices. Arch Surg 112: 1317–1321PubMedGoogle Scholar
  97. 97.
    Hirashima T, Hara T, Takeuchi H, Muto M, Shirato T, Sakuraba Y, Benitani A, Juan IK, Kuga K, Sato H, Okuda K (1980) Transabdominal esophageal mucosal transection for the control of esophageal varices. Surg Gynecol Obstet 151: 36–40PubMedGoogle Scholar
  98. 98.
    Hirashima T, Hara T, Benitani A, Juan I-K, Sato H (1982) A new stapling technique in esophageal mucosal transection. Jpn J Surg 12: 160–162PubMedGoogle Scholar
  99. 99.
    Van Kemmel M (1976) Résection: Anastomose de l’oesophage-sus-cardial pour rupture de varices oesophagiennes. Bilan d’une technique nouvelle. Nouv Press Med 5: 1123–1124Google Scholar
  100. 100.
    Johnston GW (1982) Six years’ experience of oesophageal transection for oesophageal varices, using a circular stapling gun. Gut 23: 770–773PubMedGoogle Scholar
  101. 101.
    Van Kemmel M (1982) La décompression portale hyper-sélective: Bases physiopathologiques et resultats préliminaires (à propos de 21 cas) Med Chir Dig 11: 201–210Google Scholar
  102. 102.
    Johnston GW (1985) Gun transection for oesophageal varices. In: Cushieri A, Hennessy TPKJ (eds) Current operative surgery. General Surgery, Balliere, pp 27–41Google Scholar
  103. 103.
    Spence RAJ, Johnston GW (1985) Stapled esophageal resection for varices: Results in 100 consecutive patients. Surg Gynecol Obstet 160: 323–329PubMedGoogle Scholar
  104. 104.
    Spence RAJ (1988) Oesophageal transection for varices: Rationale, indications, technique and results. In: Idezuki Y (ed) Treatment of esophageal varices Excepta Medica, Amsterdam pp 123-139Google Scholar
  105. 105.
    Giordani M, Ravo B, Sacchi M, Smith N, Ger R (1985) Treatment of bleeding esophageal varices by portoazygos disconnection and esophageal transection with the button of Boerema and EEA stapler. Ten years’ experience. Surgery 97: 649–652PubMedGoogle Scholar
  106. 106.
    Bothe A, Stone MD, McDermott WV (1985) Porto-azygos disconnection for bleeding esophageal varices. Am J Surg 149: 546–550PubMedGoogle Scholar
  107. 107.
    Manny J, Luttwak EM, Rivkind A, Eyal Z (1985) A simplified one-stage modification of portoazgous disconnection for massive variceal hemorrhage. Surg Gynecol Obstet 160: 171–172PubMedGoogle Scholar
  108. 108.
    Keagy BA, Schwartz JA, Johnson G (1986) Should ablative operations be used for bleeding esophageal varices?. Ann Surg 203: 463–469PubMedGoogle Scholar
  109. 109.
    Hassab MA (1970) Non-shunt operations in portal hypertension without cirrhosis. Surg Gynecol Obstet 131: 648–654PubMedGoogle Scholar
  110. 110.
    da Silva LC, Macedo AL, Fermanian J, da Silva AT, Strauss E, Gayotto LC, Mies S, Lacet CM, Antonelli RH, Silva EF (1986) A randomized trial for the study of the elective surgical treatment of portal hypertension in Mansoni schistosomiasis. Ann Surg 204: 140–153Google Scholar
  111. 111.
    George P, Brown C, Ridgway G, Crofts B, Sherlock S (1973) Emergency oesophageal transection in uncontrolled variceal haemorrhage. Br J Surg 60: 635–640PubMedGoogle Scholar
  112. 112.
    Mir J, Ponce J, Morena E, Juan M, Garrigues V, Pina R, Bereng ver J (1982) Esophageal transection and paraesophagogastric devascularisation performed as an emergency measure for uncontrolled variceal bleeding. Surg Gynecol Obstet 155: 868–872PubMedGoogle Scholar
  113. 113.
    Cooperman M, Fabri PJ, Martin EW, Carey LC (1980) EEA esophageal stapling for control of bleeding esophageal varices. Am J Surg 140: 821–824PubMedGoogle Scholar
  114. 114.
    Kuzmak LI (1981) Use of EEA stapler in transection of esophagus in severe haemorrhage from esophageal varices. Ann Surg 141: 387–390Google Scholar
  115. 115.
    Osborne DR, Hobbs KEF (1981) The acute treatment of haemorrhage from oesophageal varices: a comparison of oesophageal transection and staple gun anastomosis with mesocaval shunt. Br J Surg 68: 734–737PubMedGoogle Scholar
  116. 116.
    Burroughs AK, Hamilton G, Phillips A, Mezzanotte G, McIntyre N, Hobbs KEF (1989) A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices. New Engl J Med 321: 857–862PubMedGoogle Scholar
  117. 117.
    Cello JP, Cross R, Trunkey DD (1982) Endoscopic sclerotherapy versus esophageal transection in Child’s class C patients with variceal hemorrhage. Comparison with results of portacaval shunt. Surgery 91: 333–338PubMedGoogle Scholar
  118. 118.
    Umeyama K, Yoshikawa K, Yamashita T, Todo T, Satake K (1983) Transabdominal oesophageal transection for oesophageal varices: Experience in 101 patients. Br J Surg 70: 419–422PubMedGoogle Scholar
  119. 119.
    Jenkins SA, Shields R (1989) Variceal haemorrhage after failed injection sclerotherapy: The role of emergency oesophageal transection. Br J Surg 76: 49–51PubMedGoogle Scholar
  120. 120.
    Al-Kravda A, Quazi SA, Shaikh MU, Asi SA, Al-Mofarreh MA, Al-Turki M (1989) Transabdominal gastro-oesophageal devascularisation and oesophageal transection for bleeding oesophageal varices. Br J Surg 76: 943–945Google Scholar
  121. 121.
    Koyanagi N, Iso Y, Hgigashi H, Kitano S, Sugimachi K (1988) Recurrence of varices after oesophageal transection: Intra-operative and postoperative assessment by endoscopy. Br J Surg 75: 9–11PubMedGoogle Scholar
  122. 122.
    Huizinga WKJ, Angorn IB, Baker LW (1985) Esophageal transection versus injection sclerotherapy in the management of bleeding esophageal varices in patients at high risk. Surg Gynecol Obstet 160: 540–546Google Scholar
  123. 123.
    Futagawa S, Sugiura M, Hidai K, Shima F (1979) Emergency esophageal transection with paraesophagogastric devascularisation for variceal bleeding. World J Surg 3: 229–234PubMedGoogle Scholar
  124. 124.
    Suguira M, Futagawa S (1984) Esophageal transection with para-esophageal devascularisation (the Suguira procedure) in the treatment of esophageal varices. World J Surg 8: 673–682Google Scholar
  125. 125.
    Abouna GM, Baissony H, Al-Nakib BM, Menkarios AT, Silva OSG (1987) The place of Sugiura operation for portal-hypertension and bleeding esophageal varices. Surgery 101: 91–98PubMedGoogle Scholar
  126. 126.
    Barbot DJ, Rosato EF (1987) Experience in the esophagogastric devascularisation procedure. Surgery 101: 685–690PubMedGoogle Scholar
  127. 127.
    Gouge TH Ranson JHC (1986) Esophageal transection and paraesophagogastric devascularisation for bleeding esophageal varices. Am J Surg 151: 47–54PubMedGoogle Scholar
  128. 128.
    Inokuchi K, Kobayashi M, Saku M, Nagasue N, Iwaki I (1977) Transthoracic cardiectomy with infraesophago—supragastric devascularisation for bleeding esophageal varices. Jpn J Surg 7: 123–130PubMedGoogle Scholar
  129. 129.
    Yamamoto S, Hidemura R, Sawada M, Takeshige K, Iwatsuki S (1976) The late results of terminal esophagoproximal gastrectomy (TEPG) with extensive devascularisation and splenectomy for bleeding esophageal varices in cirrhosis. Surgery 80: 106–114PubMedGoogle Scholar
  130. 130.
    Hirashima T, Sato H, Takeuchi H, Nakanura H, Hirota K, Hara T (1981) Evaluation of surgical treatment for esophageal varices. World J Surg 715-716Google Scholar
  131. 131.
    Inokuchi K (1985) Present status of surgical treatment of esophageal varices in Japan. A nationwide survey of 3588 patients. World J Surg 9: 171–180PubMedGoogle Scholar
  132. 132.
    Yamamoto S (1988) Indications and results of portal-azygos disconnection surgeries under endoscope assistance. In: Idezuki Y (ed) Treatment of esophageal varices. Excerpta Medica, Amsterdam, pp 141–148Google Scholar
  133. 133.
    Suguira M, Futagawa S, Fukasawa I (1988) Experience with non-shunting operation for esophageal varices 1980–87, In: Idezuki Y (ed) Treatment of esophageal varices. Excerpta Medica, Amsterdam, pp 149-159Google Scholar
  134. 134.
    Kobayashi S, Takasaki K (1988) Late results of 224 cases of esophageal transection for esophageal varices. In: Idezuki Y (ed) Treatment of esophageal varices, Excerpta Medica, Amsterdam, pp 161-166Google Scholar
  135. 135.
    Idezuki Y, Sanjo K, Koyama H, Sakamoto H, Kokudo N (1988) Indications and results of non-shunting operations for oesophageal varices. In: Idezuki Y (ed) Treatment of esophageal varices. Excerpta Medica, Amsterdam, pp 175–185Google Scholar
  136. 136.
    Tarnawski AS, Sarfeh J, Stachura J, Hajduczek A, Bui HX, Dabros W, Gergely H (1988) Micro-vascular abnormalities of the portal hypertensive gastric mucosa. Hepatology 8: 1488–1494PubMedGoogle Scholar
  137. 137.
    McCormack TT, Sims J, Eyre-Brook J, Kennedy H, Goerel J, Johnson AG, Triger DR (1985) Gastric lesions in portal hypertension: Inflammatory gastritis or congestive gastropathy. Gut 26: 1226–1232PubMedGoogle Scholar
  138. 138.
    Hosking SW, Kennedy HJ, Seddon I, Triger DR (1987) The role of propranolol in congestive gastropathy of portal hypertension. Hepatology 7: 437–441PubMedGoogle Scholar
  139. 139.
    Trudeau W, Prindiville T (1986) Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 32: 264–268PubMedGoogle Scholar
  140. 140.
    Sarin SK, Sachdev G, Nanda R, Misra SP, Broor SL (1988) Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg 75: 747–750PubMedGoogle Scholar
  141. 141.
    Hosking SW, Johnson AG (1988) Gastric varices: A proposed classification leading to management. Br J Surg 75: 195–196PubMedGoogle Scholar
  142. 142.
    Del Guercio LRM, Hodgson WJB, Morgan JC, Berman HL, Kinkhabwalla MW (1984) Splenic artery and coronary vein occlusion for bleeding esophageal varices. World J Surg 8: 680–687PubMedGoogle Scholar
  143. 143.
    Ono J, Katsuki T, Kodama Y (1987) New approach in the management of oesophageal varices. Br J Surg 74: 607–609PubMedGoogle Scholar
  144. 144.
    Sarkar PK, Samanta N, Dasgupta S, Biswas SK (1988) Selective devascularisation of stomach and lienopulmopexy for prevention of bleeding in portal hypertension with children. Kinder-Chirurgie 43: 23–26Google Scholar
  145. 145.
    Cai C-J, Wang C-P (1988) Use of staplers on oesophagogastric varices. Br J Surg 75: 1098–1099PubMedGoogle Scholar
  146. 146.
    Yu TJ, Cheng KK, Lai ST (1989) A new approach for the management of gastric varix bleeding. Chung Hua I Hsueh Tsa Chih 43: 49–56PubMedGoogle Scholar
  147. 147.
    Murata N, Beppu T, Futagawa S, Ushiyama K, Sugiura M, Wada T (1984) Influence of esophageal transection for esophageal varices on serum bile acid level. Hepatogastroenterology 31: 164–167PubMedGoogle Scholar
  148. 148.
    Spence RAJ, Johnston GW, Parks TG (1985) Oesophageal manometry in patients with varices and following oesophageal transection. Br J Surg 72: 96–98PubMedGoogle Scholar
  149. 149.
    Spence RAJ, Johnston GW, Parks TG (1985) Prolonged ambulatory pH monitoring in patients following oesophageal transection and control subjects. Br J Surg 72: 99–101PubMedGoogle Scholar
  150. 150.
    Hosking SW, Johnson AG (1987) What happens to esophageal varices after transection and devascularisation. Surgery 101: 531–534PubMedGoogle Scholar
  151. 151.
    Kokudo N, Kawasaki S, Ohashi K, Sakamoto H, Koyama H, Saryo K, Idezuki Y (1989) Effects of non-shunting operation on azygos venous blood flow in cirrhotic patients Gut 30: 1396–1400PubMedGoogle Scholar
  152. 152.
    Starzl TE, Iwatsuki S, Van Thiel DH, Gartner JC, Zitelli BJ, Malatack JJ, Schade RR, Shaw BW Jr, Hakala TR, Rosenthal JT, Porter KA (1982) Evolution of liver transplantation. Hepatology 2: 614–636PubMedGoogle Scholar
  153. 153.
    Hobbs KEF (1987) Liver transplantation. J Hepatol 4: 148–153PubMedGoogle Scholar
  154. 154.
    Iwatsuki S, Starzl TE, Todo S, Gordon RD, Esquivel CO, Tzakis AG, Makoukou L, Marsh JW, Koneru B, Stieber A (1988) Experience in 1000 liver transplants under cyclosporine— steroid therapy: A survival report. Transplant Proc 20: 498–504PubMedGoogle Scholar
  155. 155.
    Bismuth H (1988) Liver transplantation. The Paul Brousse Experience. Transplant Proc 20: 486–489PubMedGoogle Scholar
  156. 156.
    Iwatsuki S, Starzl TE, Todo S, Gordon RD, Tzakis AG, Marsh JW, Makowka L, Koneru B, Stieber A, Klintmalm G, Husberg Bo, Van Thiel D (1988) Liver transplantation in the treatment of bleeding esophageal varices. Surgery 104: 697–705PubMedGoogle Scholar
  157. 157.
    Garrett KO, Reilly JJ, Snade RR, Van Thiel DH. (1988) Bleeding esophageal varices—treatment by sclerotherapy and liver transplantation. Surgery 104: 819–823PubMedGoogle Scholar
  158. 158.
    Crass RA, Keeffe EB, Pinson CW (1989) Management of variceal hemorrhage in the potential liver transplant candidate. Am J Surg 157: 476–478PubMedGoogle Scholar

Copyright information

© Springer Japan 1991

Authors and Affiliations

  • Roy A. J. Spence
    • 1
  1. 1.Belfast City HospitalBelfastNorthern Ireland

Personalised recommendations