title: Splenic artery ligature associated with endoscopic banding for schistosomal portal hypertension.
abstract: OBJECTIVE
  To propose a less invasive surgical treatment for schistosomal portal hypertension.
  
  
  METHODS
  Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30(th) postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings.
  
  
  RESULTS
  There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion.
  
  
  CONCLUSIONS
  Ligature of the splenic artery and left gastric vein with supraumbilical laparotomy is a promising and less invasive method for treating presinusoidal schistosomiasis portal hypertension.
authors.affiliation: Renata Potonyacz Colaneri, Fabrício Ferreira Coelho, Roberto de Cleva, Marcos Vinícius Perini, Paulo Herman, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP CEP 05403-000, Brazil.
authors.forename: Renata Potonyacz
authors.initials: RP
authors.lastname: Colaneri
authors.affiliation: Renata Potonyacz Colaneri, Fabrício Ferreira Coelho, Roberto de Cleva, Marcos Vinícius Perini, Paulo Herman, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP CEP 05403-000, Brazil.
authors.forename: Fabrício Ferreira
authors.initials: FF
authors.lastname: Coelho
authors.affiliation: Renata Potonyacz Colaneri, Fabrício Ferreira Coelho, Roberto de Cleva, Marcos Vinícius Perini, Paulo Herman, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP CEP 05403-000, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: de Cleva
authors.affiliation: Renata Potonyacz Colaneri, Fabrício Ferreira Coelho, Roberto de Cleva, Marcos Vinícius Perini, Paulo Herman, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP CEP 05403-000, Brazil.
authors.forename: Marcos Vinícius
authors.initials: MV
authors.lastname: Perini
authors.affiliation: Renata Potonyacz Colaneri, Fabrício Ferreira Coelho, Roberto de Cleva, Marcos Vinícius Perini, Paulo Herman, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP CEP 05403-000, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000469:parasitology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000469:parasitology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000469:parasitology / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008026:Ligation; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017082:Portal Pressure; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012552:Schistosomiasis / Q000150:complications / Q000175:diagnosis / Q000469:parasitology*; D013157:Splenic Artery / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Endoscopic banding; Esophageal varices; Portal hypertension; Schistosomiasis; Variceal bleeding