Different transabdominal esophagogastric stapling methods for management of variceal bleeding in portal hypertension

Objective To summarize the experience in performing transabdominal esophagogastric stapling (TAEGS) for upper gastrointestinal bleeding due to portal hypertension and evaluate the therapeutic efficacy of the methods of TAEGS. Methods The results of different methods of TAEGS performed in 98 patients with portal hypertension secondary to liver cirrhosis from January 2000 to June 2003 were analyzed and compared. Results There were 1 perioperative death (3.13%) and 2 leakage of anastomosis in 32 cases receiving esophagus-esophagus stapling (EE group). There was 1 perioperative death (1.52%) and no leakage of anastomosis in 66 cases receiving esophagus-gastric stapling (EG group). No rebleeding occurred in both groups. The follow-up rate was 90.93% (29/32) and 95.45% (63/66) in EE group and EG group, respectively. The follow-up duration ranged from 3 months to 3 years and 6 months. The gastroscopy and esophageal barium photography performed 6 months after the operation showed that the gastro-esophageal varices disappeared in 23 patients (79.3%) and 60 patients (95.24%) and was obviously improved in 6 patients (20.69%) and 3 patients (4.76%) in EE group and EG group, respectively. Conclusions The therapeutic effect of pericardial devascularization plus TAGES is satisfactory because of low perioperative mortality, high rate of gastro-esophageal varices disappearance and low occurring rate of complications. The TAGES is better than transabdominal esophagus-esophagus stapling.