To evaluate the clinical efficacy of bypass combined with devascularization in the treatment of esophageal variceal bleeding in patients with cirrhotic portal hypertension.

Clinical data of 54 patients with cirrhotic portal hypertension who underwent surgery in the Third Affiliated Hospital of Sun Yat-sen University and Yuedong Hospital of the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 54 patients, 37 cases were male and 17 female, aged from 37 to 52 years with a median age of 45 years. According to the operation procedure, the patients were divided into bypass combined with devascularization group (BD group, n=22) and selective devascularization groups (SD group, n=32). The perioperative free portal vein pressure (FPP) and the venous pressure at the gastric fundus and cardiac region (GCP) were compared by t test. The incidence of postoperative complications was compared by Chi-square test.

In BD and SD groups, the FPP was (22±5) and (22±7) mmHg (1 mmHg=0.133 kPa) respectively, significantly lower than the preoperative FPP (32±4) and (31±5) mmHg (t=-17.21, -22.54; P<0.05); The GCP was (18±7) and (20±3) mmHg respectively, significantly lower than (30±5) and (29±3) mmHg before surgery (t=-13.39, -20.44; P<0.05). No significant difference was observed in the postoperative GCP and FPP between two groups (t=1.44, 0.95; P>0.05). In BD group, the recurrent rate of esophageal varices and incidence of portal hypertensive gastropathy was 9% and 18% respectively, significantly lower than 28% and 31% in SD group (χ2=5.31, 4.89; P<0.05). The incidence of rebleeding in BD group was 4% and was 3% in SD group, where no significant difference was observed (χ2=0.21, P>0.05).

Compared with selective devascularization, the combination of bypass and devascularization in treating esophageal variceal bleeding yields similar clinical efficacy, and has the advantages of lower postoperative recurrent rate of esophageal varices and incidence of portal hypertensive gastropathy.