[Transthoracic esophagus transsection for bleeding esophageal varices (author's transl)]. / Ligatuur transsecties van de oesophagus abdominaal zowel als thoracaal.

The surgical treatment of bleeding esophageal varices is still controversial: the emergency shunt operation versus the so-called "sperr-operation". In the past three decennia, Boerema, of the department of surgery of the Wilhelmina Hospital in Amsterdam, has developed several types of ligation operations. In 1967 Boerema, Klopper and Holscher described the transabdominal oesophagus transsection using the Boerema-button for bleeding oesophageal varices (la Presse Médicale). This method has been used during ten years for 64 patients: the mortality was 39%. Since 1976 a new technique has been applied; the transthoracic oesophagus transsection. Up to the present, 7 patients have been operated upon, mortality was 14%. The technique and follow-up of both methods are discussed. We believe that the last method is a gain because of the simple technique, the esophagus does not need to be opened, so no contamination, limited operation-length, little loss of blood and prevention of laparatomy. Nevertheless one disadvantage exists: the method is suitable to esophageal varices, but not to gastric varices.

Conservative surgical management of urological complications after cadaveric renal transplantation.

Review of a consecutive series of 85 cadaveric renal transplants revealed urinary fistulas in 7 cases. Bladder fistulas originated from the anterior cystostomy suture line in 3 patients and required secondary closure in every case. Ureteral fistulas from the donor ureter often required a multistaged operation. In every case the end result has been satisfactory, with closure of the fistula and preservation of renal function.