Does the Drop in Portal Pressure After Esophagogastric Devascularization and Splenectomy Influence the Variation of Variceal Calibers and the Rebleeding Rates in Schistosomiasis in Late Follow-Up?

Abstract

Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.

Anatomical Variations of Portal Venous System: Importance in Surgical Clinic

“…Thomson variants are the most well known in the surgical practice, inasmuch as the sum of the three junctions are 23,26,29 . The knowledge of the abdominal portal system anatomy allows for the planning of venous bypasses to alleviate PH, mainly when associated with upper digestive hemorrhage.…”

“…Usually, it is asymptomatic, and there is no drug treatment yet that may prevent it or promote vascular rechanneling. Eventually, its clinical practice is associated with fever PT, abdominal pain, diarrhea, ileodynamic, ascites, and bleeding of esophageal varices 23 , 26 , 29 .…”

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Figure 2 - Some anatomical variations of the abdominal portal system structure, according to Thomson (1890) classification 23 . Type I: IMV as a tributary of the SV; type II: three veins constitute the portal vein, i.e.

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