Choice of left gastric vena caval shunt for esophageal varices--its rationale and clinical results]

We have surgically treated esophageal varices, particularly by left gastric vena caval shunt (LGCS) as the first choice in patients with good liver function (n = 40). The correlation between clinical outcomes and preoperative splanchnic hemodynamics, and therapeutical plans were evaluated: 1) Operative mortality was nil with recurrence rate of 15.0% and rebleeding noted in only one case. 2) The liver function according to Child's classification showed no significant changes before and after operation. Survival rate was more than 70% with good rehabilitation rate (over 90%). 3) The presence of hyperdynamic splanchnic circulation (left gastric venous flow and gastric wall microcirculation) lead to successful clinical results. 4) Combined use of sclerotherapy was efficacious in case of persistent and recurrent varices. We conclude that LGCS is successful in treating esophageal varices in the setting of hyperdynamic portal circulation with acceptable liver function.