Recent role of Hassab's operation for cirrhotic patients: combination with endoscopic procedure for varices.
OBJECTIVE
Recently, endoscopic and radiological procedures for various symptoms related to cirrhosis have improved. Thus, the role of Hassab's operation (gastroesophageal decongestion and splenectomy) has changed for cirrhotic patients.


METHODS
Hassab's operation was performed on patients who had gastroesophageal varices that were difficult to control with balloon occluded retrograde transvenous obliteration or an endoscopic procedure, or had hypersplenism. Thirteen consecutive patients underwent this operation, and the outcomes of all patients were reviewed retrospectively.


RESULTS
There was no operative morbidity or rebleeding varices. In the preoperative endoscopic injection sclerotherapy treated group (n=6), only one patient (16.7%) developed recurrent varices. Mean platelet counts were significantly higher 6 months after surgery (201 ± 65 × 10(3)/mm(3)) than preoperatively (64 ± 54 × 10(3)/mm(3)). In patients with hepatocellular carcinoma, percutaneous therapies, such as radio frequency ablation, were safely performed with adequate therapeutic effect. Interferon therapy was given to patients with hepatitis C virus (HCV)-related cirrhosis without interruption.


CONCLUSIONS
Hassab's operation is a satisfactory approach to controlling varices, especially when combined with preoperative endoscopic treatment. Platelet counts were significantly higher after surgery. This therapy was important for cirrhotic patients contraindicated for liver transplantation in that they could continue their therapy for hepatocellular carcinoma (HCC) and HCV as needed.
Department of Gastroenterologic Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Japan. ekhayashi@hotmail.com
Hironori
H
Hayashi
Hiroyuki
H
Takamura
Yukari
Y
Yamaguchi
Yasuhiro
Y
Shoji
Hisatoshi
H
Nakagawara
Hidehiro
H
Tajima
Ichiro
I
Onishi
Hirohisa
H
Kitagawa
Takashi
T
Tani
Masato
M
Kayahara
Tetsuo
T
Ohta
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D004947:Esophagus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015911:Sclerotherapy; D013156:Splenectomy; D016896:Treatment Outcome