[Intra-operative evaluation of portal pressure and immediate results of surgical treatment of portal hypertension in schistosomotic patients submitted to esophagogastric devascularization with splenectomy].
BACKGROUND
The main cause of portal hypertension in Brazil is the hepato-splenic form of mansonic schistosomiasis and the most employed technique for the surgical approach of this disease is the esophagogastric devascularization with splenectomy, generally associated to postoperative endoscopical esophageal varices sclerotherapy. The hemodynamic alterations after surgical treatment and its possible influence on the outcome are not well established.


OBJECTIVE
To evaluate the immediate impact of esophagogastric devascularization with splenectomy upon portal pressure as well as the results of the surgical treatment on digestive hemorrhage recurrence and on esophageal varices.


METHODS
Nineteen patients with mean age of 37.9 years and portal hypertension and previous episodes of digestive hemorrhage caused by esophageal varices rupture due to hepato-splenic schistosomiasis were studied. None of the patients had received any treatment prior to the surgery and underwent to elective esophagogastric devascularization with splenectomy. Portal pressure was assessed at the beginning and at the end of esophagogastric devascularization with splenectomy through portal vein catheterization with a polyethylene catheter introduced through a jejunal branch vein. All patients were submitted to digestive endoscopy before and after the surgery, in order to classify the size of esophageal varices after esophagogastric devascularization with splenectomy according to Palmer's classification.


RESULTS
In all patients the portal pressure had diminished with a mean decrease of 31.3% after esophagogastric devascularization with splenectomy. In the postoperative endoscopic follow-up (1 month), the esophageal varices showed a statistically significant reduction in their size, when compared to the pre-surgical measurements.


CONCLUSIONS
These results have demonstrated that the esophagogastric devascularization with splenectomy promotes immediate decrease in the portal pressure and a consequent reduction in the esophageal varices size. We also observed that the risk of mortality and severe complications related to this technique is not insignificant.
Silva-Neto
Walter De Biase da
Wde B
Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO.
Cavarzan
Adalberto
A
Herman
Paulo
P
D000293:Adolescent; D000328:Adult; D004932:Esophageal and Gastric Varices / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology*; D012189:Retrospective Studies; D012421:Rupture / Q000150:complications / Q000601:surgery; D012555:Schistosomiasis mansoni / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013270:Stomach / Q000098:blood supply; D016896:Treatment Outcome