A new technique for the treatment of esophageal bleeding in portal hypertension

A new method to operate on patients with bleeding due to portal hypertension is presented. It consists of splenectomy, devascularization of the gastric corpus, fundus and distal esophagus, resection-anastomosis of the lower esophagus, selective vagotomy with pyloromyotomy, and antireflux cardioplasty. All these procedures are carried out through a laparotomy; the esophageal resection-anastomosis is performed using the American circular EEA mechanical stapler. The method was used on 15 patients; there was one postoperative death. As regards the varices, early results were optimal. No encephalopathy was observed. Endoscopic dilatation of the anastomosis was required in four cases. No recurrence of hemorrhage has yet been observed.