Splenectomy and selectively devascularization for esophageal bleeding secondary to portal hypertension

Aim: Portal hypertension is a common disease with high mortality and poor prognosis, especially in the cases of bleeding due to portal hypertension, and secondary hypersplenism. Herein, we report a case-series of 6 patients who had bleeding from esophagus varices due to complicated portal hypertension and subsequently underwent splenectomy and selectively devascularization. Our objective was to evaluate the effects of this technique on the treatment of acute recurrent esophageal bleeding secondary to portal hypertension. Methods: We retrospectively analyzed the results of 6 patients with portal hypertension who underwent splenectomy and selectively devascularization from Jan 2010 to Mar 2014. The patients had undergone repeated endoscopic hemostatic treatment, transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation or portal-vena cava shunt operation prior to splenectomy and selectively devascularization. Results: All the patients had splenectomy and selectively devascularization. The operative mortality for this procedure was null. Esophagus varices bleeding were controlled after operation in all patients. After a median follow-up of 17 months (range 3-36 months), one patient died of liver failure after 8 months; one patient had re-bleeding after 6 months and was easily controlled by medical treatment. For liver function improvement, 4 patients improved from preoperative Child class C to B. The other 2 patients improved to Child class A after surgery. Five patients had gastroscopy 6 months post surgery, and gastro-esophageal varices disappeared in 3 patients. Conclusion: Our results suggest the efficacy of splenectomy and selectively devascularization in the treatment esophagus varices bleeding due to complicated portal hypertension.