message from the past: splenectomy and devascularisation with salvage sclerotherapy in the treatment of bleeding schistosomal oesophageal varices

ABSTRACT

To study the short and long term results of splenectomy and esophagogastric devascularisation in the prevention of bleeding from esophageal varices secondary to schistosomal portal hypertension. This is a retrospective prospective study of patients, who underwent splenectomy and devascularisation for schistosomal bleeding varices during the period 1980 to 1990 at Soba university hospital. They had clinical, laboratory, and endoscopic evaluation. They were followed up for a period of 10 years [mean 4.5 years]. At follow up special emphasis was laid on recurrence of variceal hemorrhage and, or mortality. Patients with recurrent variceal bleeding received emergency treatment in the form of resuscitation, balloon tamponade when necessary, and flexible endoscopic sclerotherapy. Splenectomy and oesophagogastric devascularisation was performed in 185 patients, and devascularisation only in 5 patients. Early postoperative mortality occurred in 8 patients [4.2%]. Early recurrence of variceal bleeding occurred in 4 patients who responded to emergency treatment. Transient of treatable ascitis developed in 21% of patients, transient jaundice in 12.6%, and liver failure in 1.6%. Major postoperative septic complications occurred in 6.4%. The rate of recurrence of variceal bleeding was 18.1% within the first 5 years, and 23.6% by 10 years follow-up. Late mortality occurred in 8 patients [4.4%]. The overall mortality of the procedure was 8.4%. Splenectomy and oesophagogastric devascularisation for the treatment of schistosomal portal hypertension can be associated with a high rate of variceal rebleeding. However, when coupled with sclerotherapy for recurrence, it carries an acceptable mortality rate