Modified Hassab procedure in the management of bleeding esophageal varices--a two-year experience

Esophageal varices are one of the most common complications (varices, ascites, hypersplenism and encephalopathy) of portal hypertension. Endoscopic sclerotherapy or band ligation is the first choice for esophageal varices today. However, immediate surgical intervention is always needed whenever endoscopic therapy fails to control acute bleeding. Therefore, a simple, effective and less time-consuming procedure is worthwhile for patients who needed immediate surgical treatment.

A modified gastroesophageal decongestion and splenectomy GEDS (Hassab) was performed on patients who need immediate surgical intervention for variceal bleeding. There were 15 consecutive patients who received this operative method and the outcome of all patients were reviewed.

During follow-up, esophageal varices were resolved in 8 patients (62%), diminished in size in 3 patients (23%) and remain unchanged in 2 patients (15%). Gastric varices disappeared in all patients. The rebleeding rate was 23% in our studies. Encephalopathy was not found in all patients. Moreover, no surgical mortality was found by using this surgical method.

In this study the modified gastroesophageal decongestion and splenectomy (Hassab) was an effective life-saving procedure for its safe, simple and less time-consuming advantages. No esophageal transection was performed in this procedure; therefore esophageal fistula, which had high mortality, did not occur. We believe that our procedure may perhaps be an alternative choice for patients who need immediate surgical intervention for bleeding varices.