Splenectomy Versus Splenectomy And Vasoligation In Management Of Secondary Hypersplenism In Patients With Asymptomatic Esophageal Varices.

Background: Gastroesophgageal varices are the most serious consequence of portal hypertension due to the risk of rupture and hemorrhage, which is the most common lethal complication. Vasoligation i.e. left gastric vein ligation and devascularization of the upper 2/3 of the greater curvature of the stomach, when added to splenectomy in patients with hypersplenism and asymptomatic esophageal varices seems to be a solution against variceal bleeding. Aim of this study was to report the prophylactic effect of vasoligation when added to splenectomy versus splenectomy alone as a management of non bleeding esophageal varices. Methods: This is a prospective randomized comparative study including patients with hypersplenism with asymptomatic esophageal varices who presented to Surgery Department of Zagazig University during the period from March 2014 to March 2016. These patients were randomly divided into two groups with each had its management approach, splenectomy alone group: 17 patients and splenectomy and vasoligation group: 17 patients. The procedure was explained to the patients, and they were consented as regard to the postoperative morbidity and mortality. Results: There was statistically significant difference between both groups in which addition of vasoligation to splenectomy decreases the grade of the esophageal varices in patients with hypersplenism and asymptomatic esophageal varices (P value < 0.05). On the other hand, there was no statistical difference between the two groups as regard post-operative complication; fever (P = 0.730), chest infection (P = 0.697), portal vein thrombosis (P = 1), subphrenic collection (P = 0.310), wound infection (P = 0.310). Conclusion: Vasoligation when added to splenectomy has a significant effect on decreasing the grade of varices without additional morbidity, but unfortunately it doesn't eradicate it.