Management of bleedine oesophagogastric varices by stapled oesophageal transection and splenectomy vasoligation

ABSTRACT

This study included thirty patients presented with recurrent bleeding from oesophago-gastric varices, they were resuscitated, diagnosed by fibre-optic endoscopy and subjected to full clinical and laboratory investigations and were classified according to Child-Paugh classification as 18 patients class [A] [60%] arid 12 patients as class [B], [40%] they underwent splenectomy vasoligation, direct gastric variceal ligation and oesophageal transection using EEA stapler, patients were followed up I year for further bleeding and endoscopically to show the fate of varices. Complete eradication of varices was noted in 13 patients [46.4%] and the grade of varices greatly diminished in the others. The mortality rate was 2 patients 6.6%, complications were minors and mostly transitory. included transient dysphagia in 4 patients [13.3%] and persistant dysphagia in one patient [3.3%], pulmonary complications in 4 patients, [13.3%], gastric stasis in one patient [3.3%] and heart burn in 6 patients. [21.4%]. Late complications [in suruived 28 patients] included ascites in 5 [17.8%] patients, Encephalopathy in one [3.57%] and incisional hernia in two patients [7.14%]. It is concluded that oesophageal transection and splenectomy vasoligation with direct ligation of fundic varices in treatment of recurrent bleeing oesophagogaatric varices, is simple, effective method for variceal eradication arid control of bleeding