Effect of gastro-esophageal decongestion on variceal pressure in patients with schistosomal hepatic fibrosis.

This study includes 60 patients having schistosomal hepatic fibrosis and esophageal varices. Splenectomy alone was done for 14 patients having no history of haematemesis and gastroesophageal decongestion with splenectomy was done for the remaining 46 patients with history of haematemesis. Endoscopic variceal pressure measurements were done to all of them peroperatively and 21 days postoperatively. 17 patients, 7 after splenectomy and 10 after gastro-esophageal decongestion, were followed for 18 months post operatively. 21 days postsplenectomy, the variceal pressure dropped insignificantly from 38.09 to 33.27 cm H2O. During the following 18 months, three patients out of seven showed significant increase in variceal pressure. After decongestion with splenectomy, the mean variceal pressure dropped significantly from 42.03 to 29.17 cm H2O. For the 10 patients followed for 18 months, eight of them retained their variceal pressure as low as early postoperative figures. Thus gastro-esophageal decongestion with splenectomy is effective in reducing variceal pressure and in so doing it is better than splenectomy alone.

Portal pressure measurements before and after Hassab's decongestion operation. A preliminary report.

This preliminary study included five patients with a history of haematemesis resulting from rupture of oesophageal varices complicating schistosomal hepatic fibrosis. Simultaneous measurements were taken of the endoscopic variceal pressure (EVP) and the free portal pressure (FPP) obtained by the cannulation of a mesenteric vein radical. These measurements were taken after laparotomy, after removing the spleen and after devascularization of the lower oesophagus and upper two thirds of the stomach. At the beginning the EVP was found to be identical with the FPP. Following splenectomy, the EVP dropped from a mean of 41.9 cm H2O to a mean of 25.8 cm H2O, whereas the FPP dropped from 40.7 cm H2O to 27.8 cm H2O. After decongestion, the EVP had a mean of 21.3 cm H2O and the FPP had a mean of 32 cm H2O. Two weeks after the operation the EVP remained unchanged at the end of the operation in two cases and increased by 5 cm H2O in one case. Accordingly it was concluded that Hassab's operation results in an immediate diminution of the EVP and FPP. However, the long-term results of this operation required further studies.