Late results of an extended devascularization procedure for patients with bleeding esophageal varices.

A procedure for control of variceal bleeding has been described that involves devascularization of the distal one-third of the esophagus and upper one-half of the stomach combined with a Nissen fundoplication performed through a left lateral thoracotomy and an incision in the left diaphragm. Transection of the truncal vagi is required to devascularize effectively the distal esophagus, and thus a pyloromyotomy or pyloroplasty is added. Twelve patients who were moderately high-risk candidates underwent this procedure for control of persistent hemorrhage. There were two postoperative deaths. Four late deaths occurred at 30, 32, 36, and 48 months in patients who continued drinking. Cause of death was uncontrolled esophageal bleeding (2) and liver failure (2). The six survivors have not rebled and are living and well at 24, 48, 54, 55, 55, and 92 months.