Pericardial devascularization for the treatment of massive hemorrhage of ruptured esophageal and gastrofundic varices

Abstract

Since 1972 we have performed PCDV (pericardial devascularization) on 55 portal hypertension patients, among whom 15 underwent various shunt or nonshunt operations previously. There were 5 deaths postoperatively. Of the 50 patients discharged from the hospital 42 could be followed up. Recurrence of bleeding was seen in 8(19%) and two of them died, the lethality being 4.8%. 14 patients in this group were reoperated on, and all were found surviving on follow-up. Among them only one had slight melena.

In performing PCDV we have found that the coronary vein has a HEB (high esophageal branch) which runs forward and upward at the level of visceral surface of left lateral lobe of the liver and receives blood from the muscular layer of the esophagus about 4–5 cm above the cardia. It is the crux of PCDV to disconnect the HEB thoroughly during this procedure.

Pre and post-PCDV portal venography and measurement of portal vein pressure show the existence of the abnormal blood flow in the HEB and the importance of complete interruption of the said branch. Moreover, the portal blood perfusion of the liver is enhanced after operation. These hemodynamic changes have led us to believe that PCDV is quite a reasonable and practicable procedure.

Keywords

high esophageal branch / portal pressure / portography / pericardial devascularization