Current indications for esophageal transection with gastric devascularization in the treatment of hemorrhaging esophageal varices

: When endoscopic sclerotherapy fails or after recurrence, a surgical approach is necessary. Oesophageal transection is a rational and effective option, because, compared to the shunt, it does not change hepatic haemodynamics, it has lower operative mortality, particularly in emergency, and it does not complicate the surgical technique of a subsequent liver transplant. The authors report their own experience of 12 patients undergoing oesophageal transection out of a total 148 treated with endoscopic sclerotherapy for bleeding oesophageal varices, over a 5 year period. 4 patients were operated in emergency and 8 after haemorrhagic recurrence, 5 because of advanced hepatopathy and 3, young and Child A, because they were potential candidates for a liver transplant. Operative mortality has been nil, morbidity about 40% and the mean postoperative stay 15.4 days (range 10-21). In a mean follow up of 30 months haemorrhagic recurrence was 16.6% (2 cases); 2 patients died respectively 26 and 40 months after surgery.