[Critical evaluation of schistosomiasis portal hypertension surgery]

Abstract

There are over 100,000 patients affected by schistosomotic portal hypertension, that may suffer rupture of the esophageal varices. Besides the portal hypertension, local factors must be emphasized as responsible for the three distal centimeters of the esophagus, called "zona vulnerável" (vulnerable zone). The better liver functional reserve of these schistosomotic patients as compared to the cirrhotic, present two favorable conditions: (1) better possibility of conservative treatment during acute hemorrhage; (2) elective surgical treatment may be undergo without a mandatory step of large portal decompression. The Author only indicate surgical treatment in patients with hemorrhage antecedent and his preference consist in splenectomy plus obliterative suture of the varices at the "vulnerable zone" and when possible, ligature of left gastric vein also; 358 patients were undergone surgery with operative mortality 3.07%; 347 were followed during 1 to 25 years; late mortality 8.38%; recurrence hemorrhage 11.58%; none porto-systemic encephalopathy was observed.