Esophageal Transection after Endoscopic Sclerotherapy for Esophageal Varices -An Useful Method Modifing Fundic Patch Operation-

Ryuji Nakamura, Masatoshi Watanabe, Yoshihiko Sugimura, Eiji Meguro, Shinya Matsuno, Mitsuru Kikuchi, Kazuyoshi Saito

Department of Surgery I, Iwate Medical University School of Medicine

For patients who experienced rebleeding and/or no variceal change after repeated sclerotherapy (14 cases) as well as for those who underwent emergency sclerotherapy (2 cases), we performed esophageal transection with devascularization along the distal esophagus and the proximal stomach. The patients underwent sclerotherapy using 5% ethanolamine oleate 1 to 9 (3.8 on average) times, and 7 days to 15 months (8 months on average) before transection. Transection modified by a fundic patch operation (15 cases) or transection using EEA with fundoplication (1 case) was performed. Multiple preoperative sclerotherapy resulted in thickening and indistensibility of the esophageal wall and its hard fibrous adhesion to surrounding organs, and it increased the operation time, the volume of intraoperative hemorrhage and the frequency of vagotomy. No postoperative suture insufficiency occurred. The cumulative rate of recurrence of varices and survival of the patients were almost the same as those for patients who underwent transection without preoperative sclerotherapy. We concluded that the method of transection by a fundic patch operation has an advantage in elective surgery for the patients who had previous multiple sclerotherapy or in emergency surgery immediately after sclerotherapy.

Key words
sclerotherapy for esophageal varices, esophageal transection

Reprint requests
Ryuji Nakamura Department of Surgery I, Iwate Medical University, School of Medicine
19-1 Uchimaru, Morioka, 020 JAPAN

Accepted
February 13, 1991

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