Proximal gastric resection in the treatment of bleeding gastro-oesophageal varices in patients with portal hypertension due to extrahepatic obstruction

Proximal gastric resection is, in our opinion, the operation of choice in the treatment of recurrent haemorrhage in three groups of patients with extrahepatic portal obstruction leading to portal hypertension:— In children who are too small for splenorenal or mesocaval anastomosis, when the haemorrhage can no longer be controlled by periodic injection of the varices through an oesophagoscope.In patients of any age with no suitable radicle of the portal venous tree available for portal systemic anastomosis.In patients who have had splenectomy alone or with gastric transection, or who have had previous shunt operations which have failed to control haemorrhage.

It is the only operation short of total gastrectomy in which the varix-bearing area of the stomach is removed. Twenty-eight patients have had this operation at St. Bartholomew's Hospital in the 16-year period 1949-65. The total and late mortality (4 patients) is 14 per cent during a mean follow-up period of 10 years. Only I patient could remotely be considered as an operative death (3.5 per cent). There was no recurrence of haemorrhage in 53 per cent. Three patients (10.5 per cent) had severe haemorrhage from recurrent varices. Two of these died and are included in the mortality figures. The operative procedure is described.

A new procedure for portal decompression: proximal splenic-caval anastomosis

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