Rationale for transthoracic esophageal transection for bleeding varices.

P ORTAL-SYSTEMIC SHUNTS HAVE LONG been considered the operation of choice for bleeding from esophageal varices associated with portal hypertension, although impossible or inadvisable in many patients. It may be impossible because there is no suitable patent vein in the portal circulation to anastomose to a systemic vein, or inadvisable because the liver function is too seriously impaired for this organ to overcome the temporary strain on its metabolism which a portacaval shunt imposes or because the risk of subsequent portal systemic encephalopathy may be too great. Since attempts to stop bleeding in these patients by conservative measures were disappointing,’ some definite operative measures other than shunt surgery should be performed. Attempts to stop bleeding by operations directed to the esophageal varices”4’7”5” ’ ” range from trans-esophageal injection of varices as a minimal operation to total removal of the thoracic esophagus with replacement by jejunum. The results of these operations so far reported have been discouraging. In 1950, Walker’7 successfully treated a patient with bleeding esophageal varices by dividing the esophagus at the level of the hiatus and its reconstruction with resuture. Among the operations directed to the esophageal varices, this procedure seems to be the most complete and drastic for the interruption of the collateral blood flow to the esophageal varices and hence the most reasonable operation. This investigation was