Simple, effective procedure with few complications for esophageal varices.

The surgical morbidity, mortality, and effectiveness of a modified nonshunting operation that includes splenic artery division instead of splenectomy, devascularization, and esophageal transection (SAD group) were evaluated. Eighteen cirrhotic patients with varices who underwent this modified procedure were compared with 54 patients treated with a conventional nonshunting operation (splenectomy group). Results show that immediate effects on portal pressure and preservation of portal perfusion between the two groups were similar. The operative time is shorter (p < 0.05), and the bleeding amount is less (p < 0.005) in the SAD group than in the splenectomy group. No surgical mortality and no major complications were noted in the SAD group. A surgical mortality of 2.3% and 30% was noted for the elective and emergency operations of the splenectomy group, respectively. There was no encephalopathy in the SAD group but one in the splenectomy group. Recurrent bleeding occurred in three patients of the splenectomy group 1 year after surgery but none in the SAD group. These data indicate that this modified procedure is a simple and effective operation with few complications for esophageal varices.