Transection of the oesophagus for bleeding oesophageal varices

TLDR

Emergency ligation of bleeding oesophageal varices was performed on 38 patients using the Milnes‑Walker technique. Emergency ligation of bleeding oesophageal varices resulted in 21 of 38 patients dying in hospital, only 2 of 12 discharged patients re‑bleeding, and a 6‑month survival of 32% overall (71% in those with good liver function), prompting the authors to discontinue the technique and pursue a mesenteric caval jump graft.

Abstract

Abstract Emergency ligation of bleeding oesophageal varices using the Milnes Walker technique was performed in 38 patients. Haemorrhage continued or recurred in hospital in 11 patients, all of whom subsequently died. A further 10 patients died in hospital following operation from hepatic failure and a variety of other causes. Five patients were finally considered suitable for elective shunt surgery, but of 12 patients who were discharged without a further operation, only 2 have re-bled. Although the overall 6-month survival was 32 per cent, in patients with good preoperative liver function this rose to 71 per cent, and the simple scoring system for grading the severity of disturbance of liver function was found to be of value in predicting the outcome of surgery. Since the results of emergency ligation of bleeding oesophageal varices in our hands have been so disappointing we are currently using it less and are trying the mesenteric caval jump graft as an emergency operation for the control of bleeding varices.