Abstract
Objective: To evaluate the clinical outcome of emergency and elective operation of splenectomy with periesophagogastric devascularization in treating upper gastrointestinal hemorrhage resulted from portal hypertension. Methods: We retrospectively reviewed 219 patients of upper gastrointestinal hemorrhage resulted from portal hypertension treated using emergency or elective operation between Jul 2002 and Aug 2010. The clinical data were collected and analyzed. Results: In the group of elective operation, four patients with grade B and three with grade C died, and in the group of emergency operation, two patients with Grade B and four with Grade C died. The Grade C patients treated using emergency operation presented with a higher mortality than those treated using elective operation, but no significant difference was found (p>0.05). In the two groups, no patients with Grade A died. 17 cases (11.1%) suffered from complications in the group of elective operation and 11 cases (16.7 %) in emergency operation (p>0.05). The complication rate in patients with Grade C is significantly higher than that in patients with Grade A or B in each group (p<0.05). The hospital stay and cost in group of elective operation are significantly higher than those in group of emergency operation (p<0.05). Conclusion: The patients with Grade A or B treated using emergency operation have similar clinical outcomes as those treated using elective operation, but emergency operation may result in higher rate of death and complication in patients with Grade C.
Highlights
Upper gastrointestinal hemorrhage is one of the life-threatening complications resulted from portal hypertension
We performed a retrospective review of our experience in the treatment of upper gastrointestinal hemorrhage resulted from portal hypertension, to help general surgeons better determine the treatment strategy of the fatal condition
In terms of the treatment of upper gastrointestinal hemorrhage resulted from portal hypertension, the initial approach is a combination of vasoactive drugs, antibiotics and endoscopic therapy.[10]
Summary
Upper gastrointestinal hemorrhage is one of the life-threatening complications resulted from portal hypertension. Splenectomy with periesophagogastric devascularization is often performed for the patients with upper gastrointestinal bleeding resulted from portal hypertension. Upper gastrointestinal bleeding from portal hypertension shock and organs hypoperfusion may result in the mortality during emergency operation as high as 30%.7. In the current study, we retrospectively reviewed 219 patients of upper gastrointestinal hemorrhage resulted from portal hypertension treated using emergency or elective operation between Jul 2002 and Aug 2010. The aim of the current study was 1) To compare the clinical outcomes of emergency operation and elective operation; 2) To help surgeons make strategies for the treatment of upper gastrointestinal bleeding resulted from portal hypertension
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