PMID: 9194275Jun 1, 1997Paper

Video laparoscopy for the treatment of bleeding esophageal varices

Surgical Laparoscopy & Endoscopy
B ZilbersteinR Eshkenazy

Abstract

Bleeding from esophageal varices is the major cause of death in patients with portal hypertension. The ideal surgical procedure should effectively control bleeding, with as little impairment of liver function as possible and with low rates of encephalopathy. Based on this objective, we propose the azygoportal disconnection (APD) with splenic artery ligation, and suturing of the gastric and esophageal varies without opening the esophagus, by video laparoscopy. With the patient placed in a semigynecologic position, we use five trocars, and the intervention begins by dissection of the diaphragmatic hiatus and isolation of the esophagus. Then devascularization of the gastric fundus is accomplished. After that, dissection and ligature between clips of the splenic artery are performed. The surgery proceeds with dissection and ligation of the vessels of the lesser curvature. After orally introducing a 12-mm Fouchet probe, we suture the varices of the distal esophagus transmurally, with interrupted sutures. The procedure is accomplished with a floppy Nissen valve. Between March 1994 and May 1995, four patients were treated with this method, two men and two women with a mean age of 54 years. All of them had hepatic cirrhosis. Three pati...Continue Reading

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