Transabdominal Gastroesophageal Devascularization Without Transection for Variceal Bleeding: A Systematic Review

• Shubhanshu Vats

  Ananta Institute of Medical Sciences and Research Centre

  Author

• Hely K. Patel

  Ananta Institute of Medical Sciences and Research Centre

  Author

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Background: Transabdominal gastroesophageal devascularization without transection is a surgical intervention for managing variceal bleeding in portal hypertension, particularly in resource-limited settings where advanced procedures like transjugular intrahepatic portosystemic shunt (TIPS) are unavailable. This review evaluates its efficacy, safety, and prognostic factors, comparing outcomes between patients with chronic liver disease (CLD) and non-cirrhotic portal hypertension (NCPH).

Methods: A systematic review was conducted following STROBE guidelines, synthesizing data from observational studies and case series (1990–2023). Studies were identified through PubMed, Scopus, and Web of Science, focusing on devascularization without transection for variceal bleeding. Outcomes included perioperative mortality, rebleeding rates, complications, and long-term survival. Data were stratified by CLD (cirrhosis) and NCPH (e.g., extrahepatic portal vein obstruction [EHPVO], non-cirrhotic portal fibrosis [NCPF]). Statistical analysis involved descriptive statistics and chi-squared tests.

Results: Across 12 studies (n=650 patients), perioperative mortality was 15% (range 4–27%), with emergency procedures (40–61%) and CLD patients (20–43%) showing higher rates than elective cases (0–4%) and NCPH patients (0–9%). Rebleeding rates were 5–17%, lower in NCPH. Complications included wound infections (10–20%) and high drain output. Long-term survival was higher in NCPH (80–95%) than CLD (50–70%). Prognostic factors for mortality included Child-Pugh score ≥10, transfusions ≥20 units, and renal failure.

Conclusion: This procedure is effective for variceal bleeding, especially in NCPH patients, with low mortality in elective settings. It is a viable option in developing countries but requires cautious use in CLD emergencies.

1. Shubhanshu Vats, Ananta Institute of Medical Sciences and Research Centre

   Department of General surgery

2. Hely K. Patel, Ananta Institute of Medical Sciences and Research Centre

   Department of General Surgery

Copyright (c) 2025 Shubhanshu Vats, Hely K. Patel (Author)

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