A Meta-analysis on effectiveness of different surgical procedures in treating esophageal variceal bleeding in patients with portal hypertension

Abstract

Objective To compare the effectiveness of surgical procedures (devascularization, shunt and combined shunt and devascularization) in treating recurrent variceal bleeding and other complications in patients with portal hypertension. Methods A systematic literature search was carried out on patients with portal hypertension, and a Meta-analysis was conducted using Revman 5.3 software to evaluate the effectiveness of different surgical procedures on recurrent esophageal variceal bleeding, hepatic encephalopathy, operative mortality and survival rates. Results A total of 24 trials were finally selected using pre-determined inclusion criteria. Meta-analysis showed there was no significant difference among the three ope-rations on operative mortality (P>0.05). The rebleeding rate of the combined group was significantly lower than the devascularization group (P 0.18). The 1-year and 3-year survival rates were not significantly different between the combined and the shunt groups (both P>0.05). Conclusions Combined shunt and devascularization had better therapeutic effectiveness than either devascularization alone or shunt alone in patients with portal hypertension with a high rebleeding risk. There were no significant difference among the three surgical procedures in operative mortality. The survival rates of combined surgery were significantly better than devascrlarization alone. Key words: Portal hypertension; Devascularization; Shunt; Rebleeding; Hepatic encephalopathy