Analysis of recurrent bleeding rate after various surgical interventions in extrahepatic portal hypertension

Abstract

Aim. To compare the incidence and timing of recurrent bleeding from esophageal and gastric varices against the background of extrahepatic portal hypertension after various interventions.Materials and methods. The research methodology involved analyzing the treatment results of 131 patients with extrahepatic portal hypertension who underwent various surgical interventions from 2006 to 2020. Total dissociation of the gastroesophageal collector was carried out in 57 patients (43.5%), portosystemic shunting – in 51 (38.9%), endoscopic interventions – in 23 (17.6%).Results. When comparing the recurrent bleeding rate, it was found out that the most effective intervention is portosystemic shunting. After endoscopic interventions the bleeding rate is 65.2%, and rebleeding occurs in 13.5 ± 2.9 months. After total dissociation of the gastroesophageal collector, a recurrence-free course was observed in 35.1% of cases (p = 0.014), with timing of 25.9 ± 4.4 months (p < 0.05). In terms of timing, this did not differ from the recurrence after portosystemic shunt surgery (41.4 ± 8.2 months), but was significantly less in the bleeding rate after decompressive surgery (17.6%; p < 0.001). Conclusion. Portosystemic shunt surgery proves to be the most effective intervention in extrahepatic portal hypertension, with a five-year remission in 75% of cases. After dissociative surgeries, 35.1% of patients experienced recurrent bleeding, with average timing of 19.6 months.