Gastrointestinal varices surgery
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Differentiating Gastrointestinal varices from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Endoscopic procedures along with pharmacotherapy is the first line management of gastrointestinal varices. During endoscopic procedures the rate of hemostasis failure is almost 10%-20%, and mortality is approximately 60% if a second unsuccessful endoscopic treatment is performed without further intervention. In such situation surgical intervention may be required to achieve hemostasis and to stop the bleeding. Surgical shunts used for the management of bleeding gastrointestinal varices include pericardial devascularization plus proximal splenorenal shunt, Warren shunt,
Surgery
- Endoscopic procedures along with pharmacotherapy is the first line management of gastrointestinal varices.
- During endoscopic procedures the rate of hemostasis failure is almost 10%-20%, and mortality is approximately 60% if a second unsuccessful endoscopic treatment is performed without further intervention.
- In such situation surgical intervention may be required to achieve hemostasis and to stop the bleeding.
- The following surgical options are available:[1][2]
Shunting procedures
(a) Pericardial devascularization (PCDV) plus proximal splenorenal shunt (PSRS)
(b) A distal splenorenal shunt procedure (DSRS), also called splenorenal shunt procedure and Warren shunt
(c) Interposition shunts (interposing a graft between systemic and splanchnic venous systems)
(d) Caval-mesenteric shunts (direct anastomosis of the divided inferior vena cava to the superior mesenteric vein)
(e) End-to-end portacaval shunts with hepatic arterialization
(f) Left gastric vena-caval shunt
References
- ↑ Xu, Chong-En; Zhang, Shu-Guang; Yu, Zhen-Hai; Li, Guang-Xin; Cao, Li-Li; Ruan, Chang-Le; Li, Zhao-Ting (2004). "Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone?". Journal of Hepato-Biliary-Pancreatic Surgery. 11 (2): 129–134. doi:10.1007/s00534-003-0881-4. ISSN 0944-1166.
- ↑ Cheema MA, Shehri MY (1995). "Surgery for bleeding esophageal varices". J Pak Med Assoc. 45 (1): 6–9. PMID 7731086.