Upper gastrointestinal bleeding surgery: Difference between revisions
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*Patients should be monitored closely for bleeding for 12 to 24 hours | *Patients should be monitored closely for bleeding for 12 to 24 hours | ||
====Complications==== | ====Complications==== | ||
*Hepatic encephalopathy | *Hepatic encephalopathy<ref name="pmid8290720">{{cite journal |vauthors=Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP |title=Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review |journal=Radiographics |volume=13 |issue=6 |pages=1185–210 |year=1993 |pmid=8290720 |doi=10.1148/radiographics.13.6.8290720 |url=}}</ref> | ||
*Hemolytic anemia | *Hemolytic anemia | ||
*Intra-abdominal bleeding during stent placement | *Intra-abdominal bleeding during stent placement | ||
Revision as of 15:30, 8 November 2017
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Upper gastrointestinal bleeding Microchapters |
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Differentiating Upper Gastrointestinal Bleeding from other Diseases |
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Diagnosis |
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Treatment |
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Management |
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Surgery |
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Case Studies |
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Upper gastrointestinal bleeding surgery On the Web |
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American Roentgen Ray Society Images of Upper gastrointestinal bleeding surgery |
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Directions to Hospitals Treating Upper gastrointestinal bleeding |
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Risk calculators and risk factors for Upper gastrointestinal bleeding surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Surgery
TIPS
TIPS is a complex nonsurgical shunt which involves insertion of an expandable metal stent that bridges the hepatic vein and an intrahepatic branch of the portal vein. TIPS can halt bleeding in almost all patients, including those with bleeding refractory to other therapies.[1]
Indications
- For treatment of bleeding varices that are refractory to banding or sclerosant injection.
- For treatment of refractory variceal bleeding as a bridge to liver transplantation.
Procedure
- TIPS involves the percutaneous puncture of the right internal jugular vein and insertion of a vascular sheath into the inferior vena cava and the hepatic vein.
- A needle is inserted through the sheath, into the liver parenchyma, and then into the portal vein.
- Aspiration of blood and injection of contrast media ensure accurate placement.
- An angioplasty balloon catheter is used to dilate the tract between the hepatic and portal veins, and a stent is then placed across the tract.
- Portal venography is used to confirm the placement
- Patients should be monitored closely for bleeding for 12 to 24 hours
Complications
- Hepatic encephalopathy[2]
- Hemolytic anemia
- Intra-abdominal bleeding during stent placement
Balloon tamponade
Balloon tamponade is only used as a temporary measure in patients who fail to respond to pharmacologic and endoscopic intervention. Balloon tamponade stabilizes patients until more definitive treatment can be instituted (TIPS or liver transplantation).
Procedure
- Balloon tamponade involves the passage of a specialized nasogastric tube, fitted with an inflatable balloon.
- When the balloon is inflated, direct pressure staunches bleeding by compressing the varices.
- Controls active bleeding in 80% to 90% of patients although rebleeding after balloon deflation is common.
Indications
- For bleeding varices that are refractory to banding or sclerosant injection.
Complications
- Rebleeding upon balloon deflation
- Esophageal rupture
Emergency laparotomy
Emergency laparotomy is performed as a last resort for complications such as bleeding and perforation. Emergency laparotomy involving open exploration of the abdomen, oversewing of the ulcer (to ligate the bleeding artery), plus truncal vagotomy (to decrease acid secretion) and pyloroplasty (for improved gastric drainage).
Indications
- Treatment of bleeding ulcer that cannot be managed with endoscopy
- Treatment of patients who cannot tolerate endoscopy
Complications
- Risks of major surgery and general anesthesia
| Surgical options for upper GI bleeding | |
|---|---|
| Disease Process | Surgical Options |
| Peptic ulcer disease | Oversew |
| 3-point ligation of gastroduodenal artery | |
| Vagotomy and pyloroplasty | |
| Vagotomy and antrectomy | |
| Highly selective vagotomy | |
| Mallory-Weiss tear | Oversew |
| Dieulafoy lesion | Oversew |
| Wedge resection | |
| Varices | Portacaval shunt |
| Mesocaval shunt | |
| Distal splenorenal shunt | |
| Gastric cancer | Distal gastrectomy |
| Total gastrectomy | |
| D2 lymphadenectomy | |
| Hemobilia | Selective ligation |
| Resection of aneurysm | |
| Nonselective ligation | |
| Liver resection | |
| Aortoduodenal fistula | Angiography and stent (if hemodynamically stable) |
| Open repair | |
| Extra-anatomic bypass | |
References
- ↑ Ferral H, Bilbao JI (2005). "The difficult transjugular intrahepatic portosystemic shunt: alternative techniques and "tips" to successful shunt creation". Semin Intervent Radiol. 22 (4): 300–8. doi:10.1055/s-2005-925556. PMC 3036298. PMID 21326708.
- ↑ Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP (1993). "Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review". Radiographics. 13 (6): 1185–210. doi:10.1148/radiographics.13.6.8290720. PMID 8290720.