Gastro-esophageal decongestion and splenectomy GEDS (Hassab), in the management of bleeding varices. Review of literature.

The use of Doppler flowmetry proved the importance of hypervolemia in bleeding and showed that GEDS enhances liver perfusion confirming our findings in the Sixties. Perhiatal devascularization of lower 3-4 inches of the esophagus, complete separation of the stomach from its bed, ligation of the left gastric artery at the lesser curvature, peritonization of greater curvature, nursing the patient on his right side, suction drainage of the splenic bed, and early respiratory exercises are essential technical points. Combination with sclerotherapy is useful but esophageal transection is harmful. Variceal rebleeding varied from 5.5% in 3 years to 7% in 10 years, when done properly, to 17% and 18.8% when done incompletely; higher rates include minor bleeding of gastritis. Encephalopathy varied from nil to minimal incidence of mild forms. Thus when done properly GEDS is as effective in controlling bleeding as DSRS with better liver, better heart, better life and better survival with nil or minimal encephalopathy. Combined with sclerotherapy it forms the ideal therapy for bleeding varices in all types of pathology.