Evaluation Of Fate Of Splenectomy And Devascularisation In The Treatment Of Variceal Bleeding Patients:

Mahmoud Ibrahim Aly

SUMMARYVariceal bleeding can be spectacular with a mortality varyingfrom 15-50%. The use of vasopressin, glypressin or theSengstaken-Blackemore tube will stop the bleeding temporarily,but with little effect on eventual mortality. Porta-caval shuntingstops the bleeding but at the expense of an increased chanceof encephalopathy and no overall improvement in mortality.Trials to lower the portal hypertension were switched toless complicated surgery (especially post-operative) that selectivelylower the portal pressure at the region of the leftgastric vein, hence, the oesophageal varices, also with thenecessity of a rapid and simple technique.In this work, splenectomy and left gastric vessels ligationwith mininal devascularization was evaluated in the management ofbleeding oesophageal varices at a period of follow-up ranged from2-7 years. This study was carried out on 100 patients, all ofthem were Child’s grade (A), all experienced one or more attacksof mild to severe bleeding episodes.The complications were encephalopathy (1%) which is verylow, Ascites developed in 5 cases (5%) and jaundice in 4 patieQts(4%) with no operative or hospital mortality •.The total mortality was (15%), the most common cause ofdeath was hepatic failure 7%, followed by 4% severe bleeding and2% renal failure and 2% unrelated causes.158Variceal responce to treatment was that no one showed ~ompletedisappearance of varices, partially collapsed in 93’ andnot changed in 7 cases (7’).As regarding improvement of liver function tests, there werestatistically significant postoperative improvement of all liverfunction tests, and the operation does not cause deterioration ofliver functions.The recurrence of bleeding was 22’ which was high incidence,4 of them died (4’) due to uncontrollable bleeding and theremaining 18 patients (18’) were controlled by injectionsclerotherapy.The operation of splenectomy and devascularization is an effective,simple and safe operation in choicable cases. As regardingthe incidence of rebleeding after the operation, postoperativeinjection sclerotherapy had succeeded in stopping recurrenceof bleeding.Postoperative injection sclerotherapy is expected to be aroutine procedure in patients with residual congested varices.Such a step would complete the role of splenectomy and devascUlarisationin decreasing significantly the recurrence of bleeding.