The acute treatment of haemorrhage from oesophageal varices: A comparison of oesophageal transection and staple gun anastomosis with mesocaval shunt

Summary Two matched groups of 20 patients with bleeding oesophageal varices were treated by the same surgical team by either oesophagogastric transection and anastomosis using a mechanical stapling instrument or by mesocaval portosystemic shunt operation. Five of the patients treated by transection died postoperatively, 2 of the survivors developed portosystemic encephalopathy (PSE). 2 died later and 5 rebled. Seven of the patients who had a mesocaval shunt died postoperatively, 8 developed PSE, 3 died later and 4 rebled. It is concluded that oesophagogastric transection and anastomosis using a mechanical instrument is preferable to portal decompression for managing bleeding oesophageal varices in the urgent situation.