Long-term results of fundectomy and periesophagogastric devascularization in patients with gastric fundal variceal bleeding.

摘要

BACKGROUND: Gastric variceal bleeding is life-threatening, and occasionally it requires operative intervention, but its treatment is controversial. Based on our experience, we considered that fundectomy and periesophagogastric devascularization (FPD) offers an effective treatment method. Accordingly, this study was undertaken to document postoperative and long-term follow-up results, such as, gastric variceal bleeding recurrence and patient survival. METHODS: A retrospective analysis was conducted on 41 patients with gastric fundal variceal bleeding who underwent FPD between August 1994 and May 2005. The evaluation included clinical characteristics, operative morbidity, mortality, and long-term follow up results. RESULTS: Operative morbidity and mortality rates were 26.8% and 17.1%, respectively. Child-Pugh classification, number of previous variceal bleeding episodes, success of preoperative intervention, and ongoing active bleeding during surgery were all factors found to have significant effects on postoperative mortality. No recurrent bleeding from gastric varices was encountered over a median follow-up period of 52.1 months. The cumulative 5-year survival rate was 62.0%, and the major causes of death were hepatocellular carcinoma (HCC) and hepatic failure. CONCLUSIONS: The operative procedure used in this study resulted in a low rate of recurrent bleeding and good long-term survival. This analysis of results suggests that fundectomy and periesophagogastric devascularization is an effective therapeutic intervention in patients with fundal variceal bleeding.