Gastrointestinal varices surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:


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, interposition shunts, caval-mesenteric shunts, end-to-end portacaval shunts with hepatic arterialization, left gastric vena-caval shunt and conventional splenorenal shunt. Non-shunting surgical procedures include ligation of varices and esophageal transection, splenic artery ligation and splenectomy.


Shunting procedures

The following shunting procedures may be used for the management of gastrointestinal varices:

(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

(g) Conventional splenorenal shunt

Non-shunting procedures

The following non-shunting procedures may be used for managing uncontrolled bleeding from gastrointestinal varices:

(a) Ligation of varices and esophageal transection

(b) Splenic artery ligation

(c) Esophagogastric devascularization combined with splenectomy

(d) Splenectomy


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