SPLENECTOMY AND GASTRIC VEIN LIGATURE IN HEPATOSPLENIC SCHISTOSOMIAIS: EFFECTS UPON ESOPHAGEAL VARICEAL PRESSURE AND ENDOSCOPIC RISK FACTORS OF ESOPHAGEAL VARICEAL BLEEDING

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. Aim - 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. Conclusion - 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.