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Gastroesophageal decongestion and splenectomy in the treatment of esophageal varices in bilharzial cirrhosis: Further studies with a report on 355 operations

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  • Clinical Surgery


Abstract 1. 1. In portal obstruction, bleeding is the outcome of portal hypertension, portal hypervolemia, portal stasis, and azygos stasis. 2. 2. The presence or absence of esophageal varices, their size and extent, and the tendency to bleed, depend, to a great extent, on the presence or absence of cephalic collaterals. 3. 3. A simple technique (gastroesophageal decongestion and splenectomy), based on the previous concept, was devised in March, 1957, and carried out in 355 cases during, after, or before bleeding. This technique proved very efficient in both stopping and preventing bleeding since the recurrence was less than 3 percent. The operation, either alone or with the addition of hepatic artery ligation, also cured ascites. The operation was not followed by encephalopathy or jaundice but was followed by improvement in the liver, cardiac, lung, and gastric functions, with restoration to normal of the blood picture and marked increase in the working capacity. 4. 4. The operation led to disappearance or improvement of the varices in 91 percent of the cases. 5. 5. The operation produced significant permanent drop in the portal tension both in man and the experimental animal. Portal blood volume was reduced by 45 percent and azygos stasis was completely corrected.

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