Esplenectomia com ligadura da veia gástrica esquerda e desvascularização da grande curvatura do estômago no tratamento da esquistossomose hepatoesplênica: é necessária a escleroterapia endoscópica pós-operatória

Abstract

RESUMO -Objetivo -Com o intuito de avaliar a eficácia e a manutenção da esclerose endoscópica pós-operatória

Evaluation of patients with schistosomal portal hypertension treated in a tertiary hospital

“…Hemodynamic instability was observed in 75.5 % and blood transfusion was necessary in 74.2 % of the cases. The bleeding caused by esophageal varices rupture is the most relevant disease complication, leading to high rates of morbidity and mortality 3,4,8,10,16,17 . Considering the severity of previous bleeding episodes and the high recurrence rate in a short interval of time, moreover the high incidence of large esophageal varices and the presence of red spots, treatment should be aggressive to avoid bleeding recurrence.…”

“…Considering the severity of previous bleeding episodes and the high recurrence rate in a short interval of time, moreover the high incidence of large esophageal varices and the presence of red spots, treatment should be aggressive to avoid bleeding recurrence. The majority of groups that lead with the disease employ esophagogastric devascularization (azigo-portal disconnection) and splenectomy as the preferred surgical treatment 5,6,8,11,14 .…”

“…Upper digestive bleeding from esophageal varices may occur in approximately 60 % of the patients 4,7,8,10 . In Brazil, the annual mortality caused by schistosomiasis was estimated in 0.3 per 100.000 inhabitants and in the rural population the disease represents an important cause of death 2,9 .…”

Esclerose endoscópica das varizes esofágicas após tratamento cirúrgico da hipertensão portal em pacientes com esquistossomose hepatoesplênica

“…O artigo de FERRAZ et al (4) , publicado neste número dos ARQUIVOS de GASTROENTEROLOGIA, enfatiza o tratamento combinado da cirurgia com a endoscopia. Embora seja estudo retrospectivo, demonstra a validade da complementação com escleroterapia na erradicação das varizes remanescentes.…”

Nitric oxide monocyte production levels in patients with the hepatosplenic form of Scistosoma mansoni infection who underwent splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue in the major omentum

“…As regard to Scistosoma mansoni infection in Pernambuco State -Northeast Brazil, a spatial analysis reveals that although from 1995 to 1999 there was a spread of admissions due to this condition in the municipalities (counties) of "Sertão" (backlands or countryside) and São Francisco river valley, the number of municipalities with hospitalizations due to schistosomiasis decreased from 1995 to 1998, followed by an increase in 1999 and 2000 3 . In this State the surgical treatment for the portal hypertension in the hepatosplenic form includes splenectomy and ligature of the left gastric vein 4 ; in children, auto implantation of spleen tissue in the major omentum is added 5 . The risk of severe infection is an important health problem in splenectomized patients, greater in children, but still present in adults with the overall rate of 7.0 per 100 persons-years (95% confidence interval, 6.30 -7.78) 6 .…”