BACKGROUND: At the Clinical Hospital of the Federal University of Pernambuco the surgical treatment of hepatosplenic shistosomiasis has been done with splenectomy + left gastric vein ligature (LGVL) + devascularization of the great curvature of the stomach + postoperative endoscopic sclerosis. If the patient has gastric fundus variceals, the gastric fundus was open and the variceals sutured. The objective of this paper was to evaluate the surgical treatment proposal regarding the re-bleeding rate, mortality and laboratorials changes. METHOD: During the period between 1992 and April 1998, 131 procedures in the General Surgery Division of the Clinical Hospital. The patients were asked to return to the Hospital and underwent a clinical/laboratorial analysis. The mean follow-up was 30 months. RESULTS: The re-bleeding rate was 14,4% (16/111) and the mortality rate 5,4% (6/111). In 8 cases of re-bleeding the exteriorization was in form of melena and in 8 as hematemesis. In 3 cases the mortality was resulted of a linfoma, a hepatocarcinoma and a cardiac stroke. In two patients the death was resulted from the immediate postoperative period (sepsis and intravascular disseminated coagulation). The other death was during the late postoperative period as a result of a re-bleeding episode. Nine patients (13,2%) evaluated with portal vein thrombosis and in two a superior mesenteric vein thrombosis was identified. Hematological and biochemical data's was also analyzed. CONCLUSIONS: The authors concluded that the surgical treatment of the hepatosplenic shistosomiasis with splenectomy + LGVL + devascularization of the great curvature of the stomach + postoperative endoscopic sclerosis is a safe procedure and with results comparable with the literature, and a advantage to maintain the liver functionality. The LGVL and the direct suture of the gastric fundus variceals gave a more effective action on the esophagus-gastric variceals and a possible lower rates of portal vein thrombosis.
Hepatosplenic shistosomiasis; Splenectomy; Portal vein thrombosis
