Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16734
Revised: June 14, 2014
Accepted: July 15, 2014
Published online: November 28, 2014
AIM: To propose a less invasive surgical treatment for schistosomal portal hypertension.
METHODS: Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30th postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings.
RESULTS: There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion.
CONCLUSION: Ligature of the splenic artery and left gastric vein with supraumbilical laparotomy is a promising and less invasive method for treating presinusoidal schistosomiasis portal hypertension.
Core tip: In a recent study from our group assessing systemic and portal hemodynamic changes in schistosomal patients undergoing esophagogastric devascularization and splenectomy, we showed that the splenic artery ligature alone promotes correction of the systemic hyper-dynamic state and significantly decreases portal pressure. The objective of the present study was to propose a less invasive surgical treatment for portal hypertension in schistosomiasis, which consists of splenic artery ligature, followed by endoscopic variceal treatment. This study showed that this new technique is a promising method in the treatment of presinusoidal portal hypertension due to its less invasive characteristic.