[Recent surgical treatment of hemorrhagic diseases in the gastrointestinal tracts].

With an advent of conservative therapy for hemorrhagic gastroenterological diseases, the candidates for surgical treatment have been tremendously decreased. As to the treatment of ruptured esophagogastric varices, endoscopic injection sclerotherapy, endoscopic variceal ligation, TIPS have been practiced as a procedure of choice. Although these conservative treatments are effective and less invasive, the high incidence of rebleeding has been reported in the literature. Therefore the optimal choice is still controversial. It includes esophageal transection, selective distal splenorenal shunt. They should be considered as candidates for surgery if tests suggested that the patient could tolerate for surgical stress. On the other hand liver transplantation is considered to be an important therapeutic option in the United State for the patients with severe liver cirrhosis. Another recent advances in this field are laparoscopically assisted surgery. When bleeding is caused by divericulum or tumor of the gastrointestinal tracts, laparoscopic approach is another method of choice before laparotomy.