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New operative method for fundal variceal bleeding: Fundectomy with periesophagogastric devascularization

Title
New operative method for fundal variceal bleeding: Fundectomy with periesophagogastric devascularization
Authors
Han, HSYi, NJKim, YWFleischer, GD
Ewha Authors
한호성
Issue Date
2004
Journal Title
WORLD JOURNAL OF SURGERY
ISSN
0364-2313JCR Link
Citation
vol. 28, no. 4, pp. 406 - 410
Publisher
SPRINGER-VERLAG
Indexed
SCI; SCIE; SCOPUS WOS
Abstract
Cirrhotic patients with gastric fundal bleeding occasionally require operative intervention. Fundal variceal bleeding may be controlled by performing a fundectomy in addition to periesophagogastric devascularization. For 23 patients with cirrhosis, preoperative nonsurgical intervention alone could not achieve definitive control of variceal bleeding from the gastric fundus, and periesophagogastric devascularization with the fundectomy-specifically resection of the varix-bearing lesion in the fundus-was performed. Direct inspection and palpation determined the area for the fundectomy, and resection was limited to the engorged varix-bearing area. The overall mortality rate was 26.1%. There were two postoperative deaths (18.2%) among 11 patients in the elective operation group and four deaths (33.3%) among 12 patients in the emergency operation group (p > 0.05). The mortality rates among class A, B, and C patients, following the Child-Pugh classification for hepatic functional reserve, were 0% (0/4), 23.1% (3/13), and 50.0% (3/6), respectively (p > 0.05). The patients who died had been transfused preoperatively with a mean of 13.0 +/- 10.5 units, and those who survived received a mean of 6.00 +/- 5.96 units (p > 0.05). Patients who were successfully stabilized by preoperative endoscopic intervention had significantly lower mortality (p < 0.001). During follow-up there was no recurrent bleeding from gastric varices, and there was only one case (4.35%) of hemorrhage from esophageal varices. Hence, periesophagogastric devascularization and fundectomy offers an alternative operative method for cirrhotic patients with variceal hemorrhaging from the gastric fundus.
DOI
10.1007/s00268-003-6923-x
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의학전문대학원 > 의학과 > Journal papers
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