World Journal of Surgery

, Volume 34, Issue 11, pp 2682–2688 | Cite as

Long-Term Results of Esophagogastric Devascularization and Splenectomy Associated with Endoscopic Treatment in Schistosomal Portal Hypertension

  • Fabio Ferrari Makdissi
  • Paulo Herman
  • Vincenzo Pugliese
  • Roberto de Cleva
  • William Abrão Saad
  • Ivan Cecconello
  • Luiz Augusto Carneiro D’Albuquerque
Article

Abstract

Background

Esophagogastric devascularization and splenectomy (EGDS) is the most performed operation for prophylaxis of esophageal varices bleeding recurrence in hepatosplenic schistosomiasis. Lower rebleeding rates are obtained through the association of postoperative endoscopic treatment; however, there is a dearth of studies showing long-term results.

Methods

Clinical, laboratory, and endoscopic data of 97 patients submitted to EGDS with at least 5 years of follow-up, were analyzed.

Results

The mean follow-up was 116.4 months. Bleeding recurrence occurred in 24.7% of patients; however, this percentage was 14.6% when only variceal hemorrhage was considered. Bleeding recurrence occurred in four patients even after endoscopic evaluation demonstrated esophageal varices eradication. In the late follow-up we observed normalization of anemia, leukopenia, thrombocytopenia, hyperbilirubinemia, and a prothrombin activity time increase. No clinical or laboratory hepatic insufficiency was observed.

Conclusions

The EGDS procedure with postoperative endoscopic treatment led to good clinical results and avoided hemorrhagic recurrence in 75.3% of schistosomal patients. There was improvement of laboratory measures of hepatic function, as well as correction of hypersplenism. Variceal hemorrhagic recurrence may occur even when esophageal varices eradication is reached.

Keywords

Schistosomiasis Esophageal Varix Gastric Varix Late Postoperative Period Endoscopic Sclerotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Fabio Ferrari Makdissi
    • 1
  • Paulo Herman
    • 1
  • Vincenzo Pugliese
    • 1
  • Roberto de Cleva
    • 1
  • William Abrão Saad
    • 1
  • Ivan Cecconello
    • 1
  • Luiz Augusto Carneiro D’Albuquerque
    • 1
  1. 1.Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil

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