TY - JOUR
T1 - Unshuntable extrahepatic portal hypertension revisited
T2 - 43 years' experience with radical esophagogastrectomy treatment of bleeding esophagogastric varices
AU - Orloff, Marshall J.
AU - Orloff, Mark S.
AU - Orloff, Susan
AU - Orloff, Lisa A.
AU - Daily, Pat O.
AU - Girard, Barbara
AU - Isenberg, Jon I.
AU - Wheeler, Henry O.
PY - 2014/1
Y1 - 2014/1
N2 - Background In 1994, the authors reported their experience with radical esophagogastrectomy for bleeding esophagogastric varices due to unshuntable extra-hepatic portal hypertension. Since then, the series has expanded from 22 to 44 patients. The aim of this study was to assess the validity of the previous observations and conclusions in the largest series with the longest follow-up. Methods From 1968 to 2005, 44 patients with unshuntable extra-hepatic portal hypertension were treated by total gastrectomy and resection of the distal two thirds of the esophagus. Before referral, the patients experienced 4 to 24 episodes of variceal bleeding requiring a mean 130 U of blood transfusion, 15 hospital admissions, and 6 previous unsuccessful operations. Results Transient postoperative complications occurred in 50% of patients. The survival rate is 100%, with no recurrence of variceal bleeding during 7 to 43 years of follow-up. Liver function and biopsy results have been normal. Quality of life has been excellent or good in 91%. Eighty-six percent have resumed employment or full-time housekeeping. Conclusions In unshuntable extra-hepatic portal hypertension, radical esophagogastrectomy is the only consistently effective treatment of variceal hemorrhage. Prompt use of this lifesaving procedure is warranted.
AB - Background In 1994, the authors reported their experience with radical esophagogastrectomy for bleeding esophagogastric varices due to unshuntable extra-hepatic portal hypertension. Since then, the series has expanded from 22 to 44 patients. The aim of this study was to assess the validity of the previous observations and conclusions in the largest series with the longest follow-up. Methods From 1968 to 2005, 44 patients with unshuntable extra-hepatic portal hypertension were treated by total gastrectomy and resection of the distal two thirds of the esophagus. Before referral, the patients experienced 4 to 24 episodes of variceal bleeding requiring a mean 130 U of blood transfusion, 15 hospital admissions, and 6 previous unsuccessful operations. Results Transient postoperative complications occurred in 50% of patients. The survival rate is 100%, with no recurrence of variceal bleeding during 7 to 43 years of follow-up. Liver function and biopsy results have been normal. Quality of life has been excellent or good in 91%. Eighty-six percent have resumed employment or full-time housekeeping. Conclusions In unshuntable extra-hepatic portal hypertension, radical esophagogastrectomy is the only consistently effective treatment of variceal hemorrhage. Prompt use of this lifesaving procedure is warranted.
KW - Bleeding esophagogastric varices
KW - Radical esophagogastrectomy
KW - Unshuntable extrahepatic portal hypertension
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U2 - 10.1016/j.amjsurg.2013.06.001
DO - 10.1016/j.amjsurg.2013.06.001
M3 - Article
C2 - 24070666
AN - SCOPUS:84890440876
VL - 207
SP - 46
EP - 52
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 1
ER -