Original communication| Volume 81, ISSUE 4, P382-385, April 1977

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Ligation procedures in the management of portal hypertension

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      In the 10 year period from 1964 through 1973, 25 patients bleeding from esophageal varices underwent ligation procedures coupled with splenectomy rather than a shunt. These procedures included the transesophageal and transgastric approaches and extragastric legations. For patients with normal liver function, the risk of this urgent or emergency surgery is comparatively low (two of 12 patients died). The chance of recurrent hemorrhage is high (nine of nine surviving patients), as is the need for subsequent surgery (eight of nine patients). Nevertheless, despite these drawbacks, nine of these 12 patients (75 percent) are alive, and seven have survived 5 or more years. In patients with cirrhosis, the initial operative mortality rate (three of 12 patients) and the subsequent mortality rate (five additional patients) reflect the greater risk because of liver disease. Only five of 13 patients (38 percent) survive, three of whom are alive 5 or more years after their initial surgery. These results indicate that there are situations when ligation procedures are valuable, especially in the noncirrhotic patient.
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        • Baum S.
        • Nusbaum M.
        The control of gastrointestinal hemorrhage by selective mesenteric arterial infusion of vasopressin.
        Radiology. 1971; 98: 497
        • Boerema I.
        Surgical therapy of Weeding varices of the esophagus during hepatic cirrhosis and Banti's disease.
        Ned. Tijdschr. Geneeskd. 1949; 93: 4174
        • Britton R.C.
        • Crile G.C.
        Late results of transesophageal suture of bleeding esophageal varices.
        Surg. Gynecol. Obstet. 1963; 117: 10
        • Conn H.O.
        • Ramsby G.R.
        • Storer E.H.
        • et al.
        Intra-arterial vasopressin in the treatment of upper gastrointestinal hemorrhage: A prospective, controlled clinical trial.
        Gastroenterology. 1975; 68: 211
        • Crile Jr., G.
        Transesophageal ligation of bleeding esophageal varices; a preliminary report of 7 cases. 1950; 61: 654
        • Fonkalsrud E.W.
        • Myers N.A.
        • Robinson M.J.
        Management of extrahepatic portal hypertension in children.
        Ann. Surg. 1974; 180: 487
        • Hassab M.A.
        Nonshunt operations in portal hypertension without cirrhosis.
        Surg. Gynecol. Obstet. 1970; 131: 648
        • Hermann R.E.
        • Esselstyn Jr., C.B.
        The potential hazard of pregnancy in extrahepatic: portal hypertension.
        Arch. Surg. 1967; 95: 956
        • Hermann R.E.
        • Traul D.
        Experience with the Sengstaken-Blakemore tube for bleeding esophageal varices.
        Surg. Gynecol. Obstet. 1970; 130: 879
        • Hermann R.E.
        • Rodriquez A.E.
        • McCormack L.J.
        Selection of patients for portal-systemic shunts.
        J. A. M. A. 1966; 196: 1039
        • Johnson G.
        • Dart Jr., C.H.
        • Peters R.M.
        • et al.
        Hemodynamic changes with cirrhosis of the liver: Control of arteriovenous shunts during operation for esophageal varices.
        Ann. Surg. 1966; 163: 692
        • Johnston G.W.
        • Rodgers H.W.
        Review of 15 years' experience in use of sclerotherapy in control of acute hemorrhage from esophageal varices.
        Br. J. Surg. 1973; 60: 797
        • Pitcher J.L.
        Safety and effectiveness of the modified Sengstaken-Blakemore tube: A prospective study.
        Gastroenterology. 1971; 61: 291
        • Pugh R.N.
        • Murray-Lyon I.M.
        • Dawson J.L.
        • et al.
        Transection of the esophagus for bleeding esophageal varices.
        Br. J. Surg. 1973; 60: 649
      1. Rosch, J.: Personal communication.

        • Skinner D.B.
        Transthoracic, transgastric interruption of bleeding esophageal varices.
        Arch. Surg. 1969; 99: 447
        • Smith G.W.
        Splenectomy and coronary vein ligation for the control of bleeding esophageal varices.
        Am. J. Surg. 1970; 119: 122
        • Wirthlin L.S.
        • Linton R.R.
        • Ellis D.S.
        Transthoracoesophageal ligation of bleeding esophageal varices.
        Arch. Surg. 1974; 109: 688
        • Wirthlin L.S.
        • Van Urk H.
        • Malt R.B.
        • et al.
        Predictors of surgical mortality in patients with cirrhosis and non-variceal gastrointestinal bleeding.
        Surg. Gynecol. Obstet. 1974; 139: 65