Management of variceal bleeding risk in portal hypertension surgery

Abstract

Introduction. The presence of portal hypertension (PHT), and esogastric varicose veins (EGVV) negatively influences the risk of bleeding and requires the promotion of safer elimination, reduction and attenuation practices. Purpose. Analysis of postoperative results in the multidisciplinary management process adapted to the needs of the cirrhotic patient of surgical interest. Material and methods. 366 cases were analyzed, cirrhotic patients with PHT, hospitalized and operated on for a period of 20 years. Predominantly were performed azygo-portal devascularization Hassab: open approach (302) and laparoscopic (38). Prophylaxis of variceal hemorrhage (VH) in patients with risk of hemorrhage also included the endoscopic approach to a EGVV by elastic ligatures (EL): 312 sessions in 261 cases. Results. The postoperative evolution was burdened by a series of complications in proportion of 14.5% (53 cases): acute postplenectomy pancreatitis (6), portal vein thrombosis (18 acute / 5 chronic), abscess under the diaphragm (9), ascites-peritonitis (1), hepato-renal failure (4), others (10). Intraoperative mortality - zero, postoperative - 3.55%. At 1 year postoperatively, EV regression and a low incidence of VH (2/261) were observed with one death which emphasizes the effectiveness of surgical treatment associated with EL. Conclusions. Combined treatment (surgical and endoscopic) is an effective option in reducing the risk of bleeding with a positive impact on the pathological context and therapeutic success.