Bleeding oesophageal and gastric varices: stapling procedures

Since Boerema and Crile first described direct ligation of oesophageal varices by a transthoracic approach there have been many modifications of the method. Japanese surgeons, disillusioned by the results of shunt surgery, employed transthoracic paraoesophageal devascularization and oesophageal transection combined with an abdominal component consisting of splenectomy and devascularization of the upper stomach together with vagotomy and pyloroplastyl. This extensive operation has never gained popularity in the West, and even in Japan thoracotomy is now included less frequently. The advent of mechanical staplers has renewed interest in the transection—devascularization procedures.