Portal hypertension in schistosomiasis: A long-term follow-up of a randomized trial comparing three types of surgery

Abstract

The long-term follow-up of patients with the severe form of Manson's schistosomiasis who had had elective surgical treatment for portal hypertension, in a randomized trial, was clinically evaluated. Of 94 patients, proximal splenorenal shunting was performed in 32, esophagogastric devascularization with splenectomy in 32 and distal splenorenal shunting in 30. Patients were observed during a mean of 85.7 +/- 33.1 mo, excluding nine patients (9.6%) who were lost to follow-up. Recurrence of upper gastrointestinal tract bleeding occurred in 24.1% of the patients, without statistical differences among the three groups, but rebleeding because of varices was more frequent after esophagogastric devascularization with splenectomy. Hepatic encephalopathy was significantly higher after proximal splenorenal shunting (39.3%) when compared with distal splenorenal shunting (14.8%) and with esophagogastric devascularization with splenectomy (0%). Lethality was also significantly higher after proximal splenorenal shunting (42.9%) when compared with distal splenorenal shunting (14.8%) and with esophagogastric devascularization with splenectomy (7.1%). Indirect hyperbilirubinemia was absent after esophagogastric devascularization with splenectomy and more frequent after distal splenorenal shunting (52%) although also present after proximal splenorenal shunting (29.6%). Esophagogastric devascularization with splenectomy was demonstrated to be the best option because of the absence of encephalopathy and because of low mortality rates. Hepatic encephalopathy occurred after distal splenorenal shunting but in a lesser percentage than after proximal splenorenal shunting. The higher incidence of encephalopathy and lethality proscribes proximal splenorenal shunting in Manson'schistosomiasis.

Splenic artery ligation and distal splenorenal shunt in schistosomiasis

“…After a 2-year follow-up, none of the patients had died. According to the literature, mortality rates after DSRS in patients with schistosomal portal hypertension ranges from 2.2 to 14.8% [6,9]. Our series show that SAL did not increase the incidence of operative mortality.…”

“…Therefore, it is not so common that they develop encephalopathy as cirrhotic patients after DSRS [5]. Its occurrence may vary from 0 to 14.8%, according to some studies [9,10].…”

The Surgical Treatment for Portal Hypertension: A Systematic Review and Meta-Analysis

“…In one RCT [21], there was a significant postoperative decrease of free portal pressure and portal vein pressure in the shunt group compared with the devascularization group ( P < 0.05 for all comparisons; data not shown). Another RCT [26] showed a significant decrease of portal vein diameter in both the combined treatment and devascularization groups ( P < 0.001; data not shown). The results of portal vein pressure are shown in Figure 6 ( P < 0.0001, Odds Ratio M-H, Random, 95%  CI = 72.64 [39.53, 105.75], I 2 = 0%), while the results of portal vein diameter and free portal pressure are presented in Figure 7 ( P = 0.04, Odds Ratio M-H, Random, 95%  CI = 1.17 [0.04, 2.30], I 2 = 86%, and P = 0.0009, Odds Ratio M-H, Random, 95%  CI = 1.35 [0.55, 2.14], I 2 = 95%).…”

Association between Schistosomiasis mansoni and hepatitis C: systematic review

“…This clinical form is observed in endemic areas and is characterized by portal hypertension that may cause digestive hemorrhage. 28,42,48 When SM comes combined with other hepatic disease, especially the Hepatitis C Virus (HCV) infection, the progression of hepatic fi brosis into cirrhosis and hepatocellular carcinoma (HCC) can occur within a few years. 29,40 Concomitant SM and HCV infection is observed with high frequency in Egypt 2,7,47 and Brazil.…”