Transabdominal Gastroesophageal Devascularization Without Transection for Variceal Bleeding: A Systematic Review

Background: Transabdominal gastroesophageal devascularization without transection is a surgical intervention formanaging variceal bleeding in portal hypertension, particularly in resource-limited settings where advancedprocedures like transjugular intrahepatic portosystemic shunt (TIPS) are unavailable. This review evaluates itsefficacy, safety, and prognostic factors, comparing outcomes between patients with chronic liver disease (CLD) andnon-cirrhotic portal hypertension (NCPH).Methods: A systematic review was conducted following STROBE guidelines, synthesizing data from observationalstudies and case series (1990–2023). Studies were identified through PubMed, Scopus, and Web of Science,focusing on devascularization without transection for variceal bleeding. Outcomes included perioperative mortality,rebleeding rates, complications, and long-term survival. Data were stratified by CLD (cirrhosis) and NCPH (e.g.,extrahepatic portal vein obstruction [EHPVO], non-cirrhotic portal fibrosis [NCPF]). Statistical analysis involveddescriptive statistics and chi-squared tests.Results: Across 12 studies (n=650 patients), perioperative mortality was 15% (range 4–27%), with emergencyprocedures (40–61%) and CLD patients (20–43%) showing higher rates than elective cases (0–4%) and NCPHpatients (0–9%). Rebleeding rates were 5–17%, lower in NCPH. Complications included wound infections (10–20%) and high drain output. Long-term survival was higher in NCPH (80–95%) than CLD (50–70%). Prognosticfactors for mortality included Child-Pugh score ≥10, transfusions ≥20 units, and renal failure.Conclusion: This procedure is effective for variceal bleeding, especially in NCPH patients, with low mortality inelective settings. It is a viable option in developing countries but requires cautious use in CLD emergencies.