[Highly selection portal decompression for ruptured esophageal varices: study of a series of 122 cases with long-term results].

STUDY AIM

The aim of this retrospective study was to report the results, with a minimum 10-year follow-up, of highly selective portal decompression (HSPD) realized in order to prevent bleeding recurrences from esophageal or gastric varices in a series of 122 cirrhotic patients.

PATIENTS AND METHOD

From January 1980 to February 1997, 122 patients (85 men and 37 women, mean age: 50.4 years) with liver cirrhosis stage A (n = 6), B (n = 50), C (n = 6) according to Child classification, were operated on for bleeding varices after a delay in 106 patients, on emergency in 16 patients. The HSPD included a double vascular ligature (splenic artery ligature in case of hypersplenism [n = 42] and high perigastric veins ligature) and a double tissular stapling (low esophagus transection and valvuloplasty). Other associated procedures were performed including cholecystendesis in 21 patients.

RESULTS

Perioperative mortality rate was 8% (n = 10). There was no anastomotic leakage but anastomotic stenosis in ten patients treated by dilatation. Three patients only out of 109 (2.5%) were lost for follow-up. Portocaval encephalopathy was not observed in any patient. Global survival rate was 60% at 5 years and 45% at 10 years. The mortality rate related to recurrent esophageal varice bleeding was 11% and related to hepatocellular failure 18.5% during the entire follow-up.

CONCLUSION

HSPD appears to be the best procedure in cirrhotic patients for the prevention of recurrent esophageal varice bleeding. Preservation of portal pressure within the cirrhotic liver (whereas it is reduced in varices) contributes to the preservation of hepatocellular function, avoiding portocaval encephalopathy.