Selective surgery for bleeding oesophageal varices

ABSTRACT

Two groups of schistosomal patients with history of bleeding esophageal varices were studied. Esophagoscopy, splenoportography and intra-operative portal pressure measurements from splenic, superior mesenteric, left gastric and umbilical veins were done, and according to the hemodynamic pattern, group A were submitted to selective policy, while group B were taken as controls. All group A patients had esophageal varices mostly of the moderate and severe types. Portal pressure measurements showed either positive or negative gradients with different patterns. Splenectomy and gastro- esophageal decongestion or lienorenal shunt were selected for 17 patients with positive gradient, and splenectomy alone or splenectomy plus decongestion or lienorenal shunt for 33 patients with negative gradient. Group B patients were submitted to splenectomy plus left gastric vessels legation and were taken as controls. In group A the esophageal varices disappeared or markedly regressed in 93.75%, compared to 77.78% in group B. The follow up results showed that selective policy was better in medium term follow up [7 years]