BACKGROUND: The aim of this study is to present epidemiological data and evaluate a surgical approach in the treatment of gastric fundus varices in patients with hepatosplenic shistosomiasis. METHODS: During the period of January 1992 and July 2001, 125 patients underwent splenectomy, ligation of the left gastric vein (LLGV), devascularization of the great stomach curvature and post-operative endoscopic sclerotherapy for the treatment of hepatic-splenic schistosomiasis with previous gastrointestinal haemorrhages. In the patients who presented gastric varices in the pre-operative endoscopy (44/125), a gastrotomy and an obliterating running suture were also performed intraoperatively. RESULTS: Gastric fundus varices were observed in 35,2% of all patients with hepatic-splenic schistosomiasis with previous gastrointestinal haemorrhages (44/125). The surgical treatment proposed eradicated 76,5% of the gastric fundus varices in a mean follow-up period of 26 months. Portal vein thrombosis was higher in the group of patients without fundus grastric varices (16,3%) when compared with fundus gastric varices patients (8,8%). This difference was not statistically significant (p=0,62). There was no correlation between the presence of fundus gastric varices and the degree of periportal fibrosis or the weight of the spleen. Despite a statistically lower number of white blood cells in the gastric fundus varices, no other differences were identified in the preoperative haematological and biochemical data. CONCLUSIONS: The authors concluded that patients underwent splenectomy, ligation of the left gastric vein, devascularisation of the great stomach curvature, post-operative endoscopic sclerotherapy, gastrotomy and an obliterating running suture of the fundus gastric varices, eradicated 76,5% of the fundus gastric varices, in a follow-up of 26 months.
Shistosomiasis; Fundus gastric varices; Splenectomy; Periportal fibrosis
