PORTAL-HYPERTENSION IN SCHISTOSOMIASIS - A LONG-TERM FOLLOW-UP OF A RANDOMIZED TRIAL COMPARING 3 TYPES OF SURGERY

The long-term follow-up of patients with the severe form of Manson's s chistosomiasis who had had elective surgical treatment for portal hype rtension, in a randomized trial, was clinically evaluated. Of 94 patie nts, proximal splenorenal shunting was performed in 32, esophagogastri c devascularization with splenectomy in 32 and distal splenorenal shun ting in 30. Patients were observed during a mean of 85.7 +/- 33.1 mo, excluding nine patients (9.6%) who were lost to follow-up. Recurrence of upper gastrointestinal tract bleeding occurred in 24.1% of the pati ents, without statistical differences among the three groups, but rebl eeding because of varices was more frequent after esophagogastric deva scularization with splenectomy. Hepatic encephalopathy was significant ly higher after proximal splenorenal shunting (39.3%) when compared wi th distal splenorenal shunting (14.8%) and with esophagogastric devasc ularization with splenectomy (0%). Lethality was also significantly hi gher after proximal splenorenal shunting (42.9%) when compared with di stal splenorenal shunting (14.8%) and with esophagogastric devasculari zation with splenectomy (7.1%). Indirect hyperbilirubinemia was absent after esophagogastric devascularization with splenectomy and more fre quent after distal splenorenal shunting (52%) although also present af ter proximal splenorenal shunting (29.6%). Esophagogastric devasculari zation with splenectomy was demonstrated to be the best option because of the absence of encephalopathy and because of low mortality rates. Hepatic encephalopathy occurred after distal splenorenal shunting but in a lesser percentage than after proximal splenorenal shunting. The h igher incidence of encephalopathy and lethality proscribes proximal sp lenorenal shunting in Manson's schistosomiasis.