Segmental splenectomy and extraperitoneal splenic transposition with gastroesophageal devascularization in treatment of oesophageal varices. A new technique.

We evaluated segmental splenectomy and extraperitoneal splenic transposition with gastroesophageal devascularization (S.S.S.T.) in 30 patients with oesophageal varices (22 bleeders and 8 non-bleeders) and compared their results with those of 30 patients (22 bleeders and 8 non-bleeders) who underwent splenectomy and gastroesophageal devascularization in a randomised study. It was found (by endoscopy) after a follow-up period up to 3 years that after the operation S.S.S.T. the varices disappeared in 6.7%, reduced in 66.7% and did not change in 23.3% while in the compared operation of splenectomy and gastroesophageal devascularization only, oesophageal varices did not change in 90% and increased in grading in 10%. The percent reduction of portal pressure in our new S.S.S.T. technique was 30% after 9 months and 40.7%-60% after 2 years. This decreased portal pressure reading with longer follow-up period suggests that collaterals between the transposed splenic segment and the parieties may increase in number and/or caliber by increasing the blood flow through these collaterals. No recurrence of bleeding, no encephalopathy or mortality during the period of follow-up (3 years). No reenlargement of the transposed splenic segment (clinically and sonographically) up to 3 years of observation. Trans-segmental splenic venography and Digital Vascular Imaging (D.V.I.) had demonstrated collateral vessels between the transposed splenic segment and the parieties and reversed splenic blood flow. Also, D.V.I. showed a collateral vessel anastomosis with the renal parenchymal vessels (Splenorenal collateral or shunt).