Splenectomy only, and splenectomy with devascularisation in a rural hospital: a six years experience of a General Surgeon

ABSTRACT

Bilharzial portal hypertension is a common problem in Elgezira Scheme, Sudan, where this study was conducted. The most serious complication of this disease is bleeding from oesophageal varices, and many patients present with features of hypersplenism. Splenectomy is a known effective procedure to cure cytopenia in patients with hypersplenism but also play a role in arresting variceal bleeding when coupled with devascularization. The aim of this study is to determine the indications, outcome and complications of splenectomy only and splenectomy with devascularisation [SD] in patients with bilharzial portal hypertension in an area with limited hospital facilities. The hospital lacks equipments for sclerotherapy, has limited blood bank service, no consultant anaesthetist and no intensive care unit. The study was conducted during the period between June 1994 and June 2000 at Elmanagil hospital. This is a retrospective study and patients were followed up every 6 months for 3 years. One hundred and fifty patients underwent SD and 116 underwent splenectomy; 72% patients were males, 90% of the patients ages were between 20 - 60 years. Following splenectomy, cytopenia was corrected in all patients with hypersplenism within 3 months after operation. The recurrence rate of haematemesis was 12% in those 111 patients who could be followed up for 3 years. The commonest post operative complications were malaria [6%], chest infection [4%]. Less common complications were wound sepsis 1,5% intra - abdominal sepsis 1% and pseudopancreatic cyst 1%. Six patients died within the first 3 weeks [2.2%]. Splenectomy is an effective procedure to correct hypersplenism while SD control variceal bleeding due to bilharzial portal hypertension within 3 yrs period of follow up