BACKGROUND: Searching for that risk factors that could commit surgical treatment of patient with schistosomiasis, the authors analyzed the spleen as a prognostic factor. METHODS: Between 1992 and 1998, 114 patients underwent splenectomy with ligation of the left gastric vein (LLGV) and devascularisation of the great stomach curvature, followed by post-operative endoscopic sclerotherapy for the treatment of hepatic-splenic schistosomiasis with previous gastrointestinal haemorrhages. A clinical/laboratorial analysis was performed. Patients were divided into 3 groups according to the weight of the spleen, in the moment of the accomplishment of the histologycal cuts: GROUP I - spleen smaller than 500 grams (17); GROUP II - spleen between 500 and 1000 grams (58) and; GROUP III - spleen greater than 1000 grams (39). RESULTS: Patients of GROUP I presented rebleeding rate of 17,6%, thrombosis of the portal vein of 5,9% and there was not mortality. The incidence of preoperative hipersplenism was 29,4% and the caliber of the portal vein was 1,1 cm. In GROUP II the rebleeding rate was of 15,5%, thrombosis of the portal vein of 10,3% and the mortality incidence of hiperplenism of 4 patient (6,9%), 2 patients in the immediate postoperative period and 2 in the late followup (hepatocarcinoma and digestive hemorrhage). The hipersplenism incidence was of 53,4% and preoperative mean caliber of the portal vein was 1,4cm. In GROUP III the rebleeding incidence was 12,8%, thrombosis of the portal vein 5,1% and a late mortality of 2 patient (linfoma and miocardium infarct). The hipersplenism incidence was of 76,9% and the caliber of the portal vein was of 1,5 cm. CONCLUSIONS: Weight of the spleen presents relationship with preoperative hipersplenism, with portal vein caliber and postoperative hospitalar stay. There was no relationship with fundus gastric varices, rebleeding rate, portal vein thrombosis, degree of periportal fibrosis and biochemical data.
Hepatosplenic shistosomiasis; Splenectomy; Spleen; Risk factor; Portal vein thrombosis
