Portoazygous disconnection for bleeding esophageal varices

Between 1971 and 1982, 20 portoazygous disconnections (modified Tanner's operation) were performed in patients with bleeding esophagogastric varices who were anatomically unsuitable or at high risk for conventional portosystemic shunting. Immediate control of variceal hemorrhage was achieved in all patients, although rebleeding occurred after eight operations at intervals from 2 days to 7.5 years postoperatively, requiring additonal surgery at a mean interval of 2.5 years. There were eight perioperative deaths. Analysis has suggested increased mortality in patients with more severely impaired liver function according to Child's classification, and in patients who require urgent or emergent operations. There was an 80 percent incidence of major and minor complications. Portoazygous disconnection is not a satisfactory alternative to portosystemic shunting, except in a selected group of patients with intact hepatic function and with anatomic characteristics that preclude usual shunting procedures.