IS SPLENECTOMY NECESSARY IN DEVASCULARIZATION PROCEDURES FOR TREATMENT OF BLEEDING PORTAL-HYPERTENSION

Objective: To investigate whether splenectomy as a part of devasculari zation procedures is necessary. Design: Prospective, controlled, rando mized trial. Setting: University hospital, referral center. Patients: A total of 55 patients (Child-Pugh class A and B) with a history of bl eeding portal hypertension were treated by means of a modified Sugiura -Futagawa procedure. Twenty-three patients underwent splenectomy and 2 2 did not. Methods: Postoperative outcome was recorded and comparison of the 2 groups was done with the Fisher exact test. Kaplan-Meier surv ival curves were constructed. Main outcome and postoperative differenc es between the patients who underwent splenectomy and those who did no t were investigated. Results: Both groups were comparable in the posto perative period. Significant differences were observed in transfusion requirements and postoperative portal vein thrombosis, both favoring t he group without splenectomy. No differences in rebleeding, encephalop athy rate, operative time, or postoperative complications were observe d. Conclusion: Splenectomy is not routinely necessary in devasculariza tion procedures for bleeding portal hypertension.