Splenic artery ligation and vasoligation in the management of bleeding oesophageal varices

ABSTRACT

The effects of splenic artery ligation combined with vasoligation of the short gastric, left gastric vessels and veins around the abdominal esophagus were studied in 20 patients with bleeding esophageal varices. Follow-up period varied between 18-24 months. The liver pathology was bilharzial fibrosis in 17 [85%], mixed in 2 [10%] and post-hepatic cirrhosis in one [5%]. The patients were classified according to the modified Child's Risk Grading into grade A [20%], B [60%] and C [20%]. The drop in portal pressure varied between 23 and 5 cm/H20 [mean 8.1 cm/H20]. Recurrent bleeding after 20 months occurred in one [5%]. Postoperative ascites developed in four [20%], but was easily controlled medically. All the patients showed improvement in the peripheral blood picture. Deterioration in liver function tests occurred in one patient. None of the patients developed splenic abscess or cysts. Endoscopic follow-up showed that the varices did not disappear, but progressed. There was no operative mortality. One patient [5%] died two months postoperatively from progressive liver failure. The preliminary results of this line of treatment are encouraging, but longer follow-up is still needed