Open AccessA Randomized Trial for the Study of the Elective Surgical Treatment of Portal Hypertension in Mansonic Schistosomiasis
Author(s) -
Luiz C. da Silva,
Antônio Macedo,
Jacques Fermanian,
Edna Strauss,
Armando T. da Silva,
Sonia Foster,
Luiz Carlos da Costa Gayotto,
Elzi F. Silva,
A Raia,
Sérgio Mies,
Celina Maria Costa Lacet,
Silvano Raia,
Roberto Antonelli
Publication year - 1986
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198608000-00008
Subject(s) - medicine , portal hypertension , schistosomiasis , surgery , esophageal varices , randomization , randomized controlled trial , splenectomy , encephalopathy , portosystemic shunt , incidence (geometry) , cirrhosis , upper gastrointestinal bleeding , varices , mortality rate , varix , endoscopy , spleen , physics , optics , immunology , helminths
From 1977 to 1983, 94 patients with esophageal varices and gastrointestinal bleeding secondary to mansonic schistosomiasis were entered into a prospective randomized trial comparing the three operations mainly used in Brazil: esophagogastric devascularization associated with splenectomy (EGDS, 32 patients), classical splenorenal shunt (SRS, 32 patients), and distal splenorenal shunt (DSRS, 30 patients). The randomization was interrupted because of a significant incidence of portosystemic encephalopathy (PSE) in the SRS group (26%), as compared to the DSRS (7%) and EGDS (0%) groups. The rate of rebleeding was the same in the three groups, but the rate of failure, as defined by the presence of technical problems, postoperative complications, or death, was significantly higher in the SRS group. This 2-year follow-up shows that SRS should be abandoned in hepatosplenic schistosomiasis and that a comparison between DSRS and EGDS with a longer follow-up is urgently needed.