transperitoneal esophageal devascularization

Transabdominal esophageal devascularization for emergency surgery for acute massive hemorrhage of portal hypertension. Portal hypertension is the result of impeded blood flow to the portal system. The main clinical manifestations are congestive splenomegaly, hypersplenism, gastric fundus and esophageal varices, and a large amount of hematemesis after varicose vein rupture, which can be life-threatening. It can also cause ascites. Treatment of diseases: portal hypertension Indication Transabdominal esophageal sinus surgery is applicable to: 1. Upper gastrointestinal bleeding of portal hypertension is not effective after medical treatment. 2. The sick child is generally in poor condition and cannot tolerate shunt surgery or is too young to be suitable for shunt surgery. 3. If the child has ascites, you can choose to pass the thoracic esophagus. 4. If there is no ascites, gastric fundus ligation can be performed through the abdominal cavity. Preoperative preparation 1. Upper gastrointestinal bleeding occurs, and blood volume should be supplemented during non-surgical treatment to prevent hemorrhagic shock during operation. 2. If the liver function of the sick child is not good, attention should be paid to liver protection to prevent hepatic coma after operation. 3. Apply antibiotics to prevent infection. Surgical procedure 1. A transverse incision in the upper abdomen 2. After opening the abdomen, cut the left triangular ligament of the liver, and pull the left lobe of the liver to the right side to reveal the diaphragm and esophageal hiatus. The peritoneum of the diaphragm and the surface of the esophageal orifice was cut open. 3. Loop the lower end of the esophagus to protect the vagus nerve. 4. Make a transverse incision in the anterior wall of the stomach, put the gastrointestinal anastomosis clamp into the stomach cavity from the incision, put the tip of the forceps into the lower end of the esophagus, ligature the suture, and then tighten the stapler to achieve the rupture of the esophageal varices. The two layers of the anterior wall of the stomach were sutured intermittently with a 2-0 silk thread, and then the abdominal wall incision was sutured layer by layer.