A modified Hassab's operation for portal hypertension: experience with 562 cases

Abstract

Background: Many patients with portal hypertension require surgical treatment each year, and Hassab's operation, or esophagogastric devascularization and splenectomy, is an elective procedure. However, it is difficult to devascularize all the vessels of the upper half of the stomach and distal esophagus when hyperblastosis, edema, extensive vein conglobation, and conglutination are present during the operation. These increase the postoperative risk of repeat bleeding.

Patients and methods: We modified Hassab's operation to address the difficulties associated with devascularization in these cases. All consecutive Chinese patients with liver cirrhosis and portal hypertension who underwent the modified Hassab operation in the Second Affiliated Hospital of Xi'an Jiaotong University from September 1995 to December 2010 were included in the present retrospective study.

Results: A total of 562 modified Hassab's operations were performed, and all the emergency operations performed because of bleeding obtained hemostasis. Although the pressure and blood flow of the portal vein decreased slightly after surgery, it was still maintained at a high level. Overall, 21.8% of the patients had complications, and 4.6% of these patients died during the hospitalization period. Within the 12-month follow-up period, the overall improvement rate of varices was 98.5% and the variceal bleeding rate was 1%. The 5-year bleeding rate was 9.7%.

Conclusions: The modified Hassab operation is an effective procedure for the treatment of portal hypertension. Few early or late complications were observed among the patients.

Keywords: Devascularization; Hassab's operation; Modified; Portal hypertension.