Highly selective portal decompression for bleeding esophageal varices: report of a series of 122 patients with long-term results

Study aim: The aim of this retrospective study was to report the results, w ith a minimum 10-year follow-up, of highly selective portal decompression ( HSPD) realized in order to prevent bleeding recurrences from esophageal or gastric varices in a series of 122 cirrhotic patients. Patients and method: From January 1980 to February 1997, 122 patients (85 m en and 37 women, mean age: 50,4 years) with liver cirrhosis stage A (n=6), B (n=50), C (n=6) according to Child classification, were operated on for b leeding varices after a delay in 106 patients, on emergency in 16 patients. The HSPD included a double vascular ligature (splenic artery ligature in c ase of hypersplenism [n=42] and high perigastric veins ligature) and a doub le tissular stapling (low esophagus transection and valvuloplasty). Other a ssociated procedures were performed including cholecystendesis in 21 patien ts. Results: Perioperative mortality rate was 8% (n=10). There was no anastomot ic leakage but anastomotic stenosis in ten patients treated by dilatation. Three patients only out of 109 (2,5%) were lost for follow-up. Portocaval e ncephalopathy was not observed in any patient. Global survival rate was 60% at 5 years and 45% at 10 years. The mortality rate related to recurrent es ophageal varice bleeding was 11% and related to hepatocellular failure 18,5 % during the entire follow-up. Conclusion: HSPD appears to be the best procedure in cirrhotic patients for the prevention of recurrent esophageal varice bleeding. Preservation of po rtal pressure within the cirrhotic liver (whereas it is reduced in varices) contributes to the preservation of hepatocellular function, avoiding porto caval encephalopathy. (C) 2000 Editions scientifiques et medicales Elsevier SAS.