Surgical Procedures for Oesophageal Varices
. Surgical procedures employed for oesophageal varices
1. Endoscopic evaluation
2. Sengstaken-Blakemore tube : - If excessive bleeding prevents endoscopic examination
Sengstaken-Blakemore tube may be inserted to provide temporary haemostasis.
Once inserted the gastric balloon is inflated with varices at the oesophagogastric junction are tamponaded by the subsequent inflation of the oesophageal balloon to a ga pressure of
40 mm Hg The two remaining channels allow gastric and oesophageal aspiration
An X-ray is used to confirm the position of the tube. The balloons should be deflated after 12 hours to prevent pressure necrosis of the oesophagus
Endoscopic treatment of varices
3. Endoscopic Sclerotherapy using 5% ethanolamine oleate
4. Endoscopic Banding
5. TIPSS
Transjugular intrahepatic portosystemic stent shunt has become the main treatment of variceal haemorrhage which has not responded to drug treatment and sclerotherapy.
6. Portacaval Shunt
7. Splenorenal Shunt
8. Mesocaval Shunt
Spleno renal and porto caval shunts - Rarely considered
10. Oesophageal and / or gastricvarices secondary to splenic or portal vein thrombosis can be effectively treated by
splenectomy and gastro-oesophageal devascularisation.
11. Liver transplantation
12. Procedures for associated ascites a.) Abdominal paracentesis
b.) Peritoneovenous shunting - one end of the silastic tube in the peritoneal cavity and the other into the internal jugular vein with a one way valve in the silastic
