The influence of periportal (pipestem) fibrosis on long term results of surgical treatment for schistosomotic portal hypertension.
OBJECTIVE
To evaluate the degree of influence that periportal fibrosis has on clinical development and the long term results of surgical treatment on patients with hepatic-splenic schistosomiasis with previous gastrointestinal hemorrhages.


METHODS
During the period of 1992-1998, 111 patients underwent surgical treatment for the treatment of hepatic-splenic schistosomiasis with previous gastrointestinal hemorrhages. The degree of fibrosis was classified as: degree I - the portal spaces show a rich increase of young connective cells, a slight collagen production and a varying presence of inflammatory infiltrate. The periportal blade unchangeable (29/111); degree II - there is an expansion of the connective tissue with the emission of radial collagen septa, producing a star shaped aspect (38/111); degree III - the connective septa form bridges with other portal spaces or with the vein, with evident angiomatoid neo-formation (44/111).


CONCLUSIONS
The patients with periportal fibrosis degree I present recurrent hemorrhages statistically less than patients with periportal fibrosis degrees II and III, and that the intensity of the periportal fibrosis is not the only pathophysiological factor of the esophageal varices, gastric varices, prevalence of post-operative portal vein thrombosis and hematological and biochemical alterations of the patients with pure mansoni schistosomiasis.
Ferraz
Alvaro Antônio Bandeira
AA
Department of Surgery, Department of Internal Medicine - Gastroenterology, University Hospital, Federal University of Pernambuco, Recife, PE, Brazil.
de Albuquerque
Pedro Cavalcanti
PC
Lopes
Edmundo Pessoa de Almeida
EP
de Araújo
José Guido Corrêa
JG
Carvalho
Anderson Henrique Ferreira
AH
Ferraz
Edmundo Machado
EM
D000328:Adult; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000469:parasitology / Q000601:surgery*; D008109:Liver Diseases, Parasitic / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D012008:Recurrence; D012555:Schistosomiasis mansoni / Q000150:complications / Q000601:surgery*; D013158:Splenic Diseases / Q000469:parasitology / Q000601:surgery