title: Splenectomy and gastric vein ligature in hepatosplenic schistosomiais: effects upon esophageal variceal pressure and endoscopic risk factors of esophageal variceal bleeding.
abstract: BACKGROUND
  A significant number of patients with schistosomiasis develop the hepatosplenic form, with portal hypertension, in which bleeding caused by rupture of esophagogastric varices emerged as the leading cause of morbidity and mortality.
  
  
  OBJECTIVE
  To investigate the effects of splenectomy and ligature of the left gastric vein on risk factors for bleeding of esophagogastric varices in patients with schistosomiasis mansoni, hepatosplenic form, with a history of upper gastrointestinal bleeding.
  
  
  METHODS
  The main risk factors of bleeding from esophagogastric varices were studied in 34 patients. The following parameters were investigated: 1) esophageal variceal pressure, measured by the endoscopic pneumatic balloon technique; 2) size, fundamental color, extension and red signs of esophageal varices, gastric varices and gastropathy of portal hypertension. The evaluations were performed in the preoperative period, immediate postoperative period (between the sixth and eighth postoperative days) and the sixth month of follow-up.
  
  
  RESULTS
  The variceal pressure has fallen from 22.3+/-2.6 mmHg before surgery to 16.0+/-3.0 mmHg in the immediate postoperative period (p<0.001), reaching 13.3+/- 2.6 mmHg in the sixth month of follow-up. A significant reduction of the frequency of the parameters associated with a greater risk of hemorrhage was observed between the preoperative period and six-month follow-up, when the proportion of large esophageal varices (p<0.05), varices extending to the upper esophagus (p<0.05), bluish varices (p<0.01), varices with red signs (p<0.01) and gastropathy (p<0.05) decreased.
  
  
  CONCLUSIONS
  In patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage, splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good way to control the bleeding episodes.
authors.affiliation: General Surgery and Hepatic Transplant Service, Oswaldo Cruz University Hospital, Pernambuco University, Recife, PE, Brazil.
authors.forename: João
authors.initials: J
authors.lastname: Evangelista-Neto
authors.forename: Fernanda Fernandez
authors.initials: FF
authors.lastname: Pereira
authors.forename: Suênia Tavares
authors.initials: ST
authors.lastname: França
authors.forename: Fernando José
authors.initials: FJ
authors.lastname: Amaral
authors.forename: Carlos Teixeira
authors.initials: CT
authors.lastname: Brandt
authors.forename: Olival Cirilo Lucena da
authors.initials: OC
authors.lastname: Fonseca-Neto
authors.forename: Cláudio Moura
authors.initials: CM
authors.lastname: Lacerda
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008109:Liver Diseases, Parasitic / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012555:Schistosomiasis mansoni / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects*; D013158:Splenic Diseases / Q000150:complications / Q000469:parasitology* / Q000601:surgery*; D013270:Stomach / Q000098:blood supply; D014680:Veins; D055815:Young Adult