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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Acute variceal hemorrhage: the persistent bleeder. A plea for management
M S Barsoum1, F I Boulos, A M Aly
1Department of Surgery, Kasr El Aini School of Medicine, Cairo University, Egypt.
World Journal of Surgery
|March 1, 1994
Summary
Rigid sclerotherapy effectively controls acute bleeding from esophagogastric varices but has higher morbidity. Early intervention and repeated sessions are crucial, with surgery recommended for persistent or recurrent bleeding.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopic Interventions
Background:
- Esophagogastric varices pose a significant bleeding risk.
- Sclerotherapy is a common management strategy.
Purpose of the Study:
- To evaluate different sclerotherapy techniques and surgical adjuncts for managing acute variceal bleeding.
- To determine optimal timing and frequency of sclerotherapy sessions.
Main Methods:
- Comparative analysis of rigid versus flexible sclerotherapy.
- Evaluation of intravariceal versus paravariceal injection techniques.
- Assessment of surgery alone versus combined surgery and sclerotherapy.
- Analysis of management strategies for sclerotherapy failures and recurrences.
Main Results:
- Rigid sclerotherapy showed superior emergency bleeding control but higher morbidity compared to flexible.
- Intravariceal injection resulted in higher varix obliteration rates than paravariceal.
- Combined sclerotherapy with splenectomy and devascularization was more effective than surgery alone.
- No significant improvement in survival was observed across different modalities.
Conclusions:
- Early emergency sclerotherapy with repeated sessions (every 2 weeks) is recommended.
- Surgery is indicated for refractory or recurrent bleeding after multiple sclerotherapy attempts.
- While effective for bleeding control, sclerotherapy modalities did not significantly impact long-term survival.
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