Effect of esophagogastric devascularization with splenectomy on schistossomal portal hypertension patients' immunity

Abstract

-Background -Surgical treatment of hemorrhagic complication in schistosomal portal hypertension in our hospital is an esophagogastric devascularization procedure with splenectomy. Infectious risks and immunological alterations imputed to splenectomy may have signifi cant importance. To minimize the consequences of spleen absence, the use of subtotal splenectomy and spleen auto-transplantation were stimulated. Aim -To verify the immunologic alterations imposed by this procedure in our patients. Method -Twenty-eight patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophagogastric varices rupture underwent elective esophagogastric devascularization and splenectomy. They were prospectively studied before esophagogastric devascularization procedure with splenectomy, 15 and 30 days, 3 and 6 months after the procedure. T and B-lymphocytes, CD4 and CD8 subpopulations were determinated by monoclonal antibodies. Immunoglobulins A, M, G and C3, C4 components of the complement were determinated by radial immunodiffusion. Results -We observed important reduction of all immune cells, increase of IgG and normal levels of IgM, IgA, C3 and C4 at preoperative. CD4/CD8 relation was normal. Six months after esophagogastric devascularization procedure with splenectomy, signifi cant increase in T-lymphocytes, CD4, CD8 and B-lymphocytes were observed. CD4/CD8 relation remained normal. We noted signifi cant increase in C3. IgA, IgM, IgG and C4 had increased, but without signifi cant difference. Conclusion -Esophagogastric devascularization procedure with splenectomy determines an increase in T and B-lymphocytes, CD4 and CD8 subpopulations without compromising immunoglobulins and components of complement levels.

Laparoscopic Splenectomy and Esophagogastric Devascularization Is a Safe, Effective, Minimally Invasive Alternative for the Treatment of Portal Hypertension With Refractory Variceal Bleeding

“…14 The ideal surgical treatment for patients with portal hypertension and refractory variceal bleeding should not only control bleeding effectively but also correct hypersplenism with little impairment of liver function. 5 We prefer performing OSED for patients with portal hypertension and severe gastroesophageal varices for 3 reasons: (1) this operation has been proved to be effective in controlling bleeding by a number of studies 15,16 ; (2) there is a very low incidence of encephalopathy or liver failure, and patients have a favorable long-term survival rate because of the maintenance of postoperative portal perfusion containing hepatotrophic factors, 17 which is an outstanding advantage when compared with TIPS; and (3) this procedure can also treat hypersplenism at the same time.…”

Doppler Ultrasound Could Predict Varices Progression and Rebleeding After Portal Hypertension Surgery: Lessons from 146 EGDS and 10 Years of Follow‐Up

“…All 146 patients had negative serology for hepatitis types B and C, preserved liver function and normal proteinograms, classified as CHILD A. None of the participants had been vaccinated against Pneumococcus or Haemophilus [8]. EGDS was performed in compliance with our group standards [4].…”

“…It also has a low morbidity rate, does not cause postoperative encephalopathy, and improves patient cellular immunity. Arguments against using the procedure include higher rates of hemorrhagic recurrence and portal vein thromboses [1–8].…”

Influência da inversão do diâmetro veia porta/veia esplênica nos resultados do tratamento cirúrgico da hipertensão portal esquistossomótica

“…Surgical treatment of schistosomal portal hypertension by splenectomy with ligation of left gastric vein, followed by postoperative endoscopic sclerosis is indicated in cases associated with prior upper gastrointestinal bleeding due to rupture of esophageal varices and/or gastric ulcers, or in cases of hypersplenism with important clinical consequences for the patient 1 In an attempt to identify risk factors that may compromise the postoperative outcome of patients undergoing surgery for disconnection and splenectomy, several authors have tried to preoperatively identify parameters that can improve late results in this group of patients, mainly with respect to rebleeding [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”