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  • Title: [Esophageal varices and portal hypertension in children; experiences with Vossschulte's method of dissection ligature].
    Author: Van Der Staak FH.
    Journal: Tijdschr Kindergeneeskd; 1983 Oct; 51(5):163-71. PubMed ID: 6670089.
    Abstract:
    The optimal treatment of esophageal varices in childhood is an unresolved issue. Despite numerous studies concerning this topic, there seems to be no completely satisfying solution. An open and functioning portasystemic shunt provides a high degree of protection against esophageal variceal bleeding. However, technical obstacles imposed by the size of vessels available for shunting, reluctance to remove the spleen in a child and abnormalities of the portal vein often preclude successful portasystemic shunting in children. Therefore, a two-stage management has been proposed for the treatment of esophageal varices in childhood. In this approach Vossschulte's dissection-ligature has been utilized as a temporizing procedure. This operation has to bridge the time, until a decompressive shunt can be accomplished. Nine children with esophageal varices were treated by the dissection-ligature. There was no operative mortality. One patient succumbed during the follow-up period. One patient had a recurrent bleeding after 2 2/12 yrs, and underwent a shunting procedure at that time. Three patients had an esophageal stricture and swallowing difficulties. They were without complaints after a few dilatations. Data obtained from this study and from the literature indicate, that the dissection-ligature is safe and effective in controlling esophageal variceal bleeding. The dissection-ligature satisfies as temporary measure in the proposed two-stage management. Since many patients did not have any new bleeding-episodes and did not need any further surgery as well, it may be suggested that the dissection-ligature is not only suitable for temporary treatment, but also for permanent treatment. The dissection-ligature of Vossschulte should be kept in mind, if one is forced to consider a 'direct operation' of esophageal varices.
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