Splenectomy with endoscopic variceal ligation is superior to splenectomy with pericardial devascularization in treatment of portal hypertension.
OBJECTIVE
To investigate the therapeutic efficacy and complications of splenectomy with endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization (i.e. Hassab's operation) in patients with portal hypertension.


METHODS
A total of 103 patients with liver cirrhosis and portal hypertension were randomly selected to receive either splenectomy with EVL (n = 53, group A) or Hassab's operation (n = 50, group B).


RESULTS
The portal blood flow volume, the presence of portal vein thrombosis, gastric emptying time and free portal venous pressure (FPP) before and after the operation were determined. Patients were followed up for up to 64 mo with an average of 45 mo, and the Dagradi classification of variceal veins and the grading of portal hypertension gastropathy (PHG) were evaluated. It was found that all esophageal varices were occluded or decreased to grade II or less in both groups. There was little difference in the recurrence rate of esophageal varices (11.9% vs 13.2%) and the re-bleeding rate (7.1% vs 5.3%) between groups A and B. The incidence of complications and the percentage of patients with severe PHG after the operation were significantly higher in group B (60.0% and 52.0%) than in group A (32.1% and 20.8%, P < 0.05). No patients died of operation-related complications. There was no significant difference in gastric emptying time, FPP and portal blood flow volume between the two groups.


CONCLUSIONS
The results suggest that splenectomy with EVL achieves similar therapeutic efficacy to that of Hassab's operation in terms of the recurrence rate of esophageal varices and the re-bleeding rate, but the former results in fewer and milder complications.
Lin
Nan
N
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Provice, China.
Liu
Bo
B
Xu
Rui-Yun
RY
Fang
He-Ping
HP
Deng
Mei-Hai
MH
D005260:Female; D005746:Gastric Emptying; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008026:Ligation / Q000009:adverse effects / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008297:Male; D011168:Portal System; D011169:Portal Vein / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013927:Thrombosis; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color