Resultados a medio-largo plazo de la técnica de Han en tratamiento de pacientes con varices y trombosis porto-espleno-mesentérica

Resumo

INTRODUCTION. The digest variceal bleeding is one of the most serious complications of portal hypertension. If endoscopic therapy fails come be necessary to surgical treatment with portosystemical shunt or esophagogastric devascularization. CLINIC CASE 1. We present the case of a 49-year-old man with alcoholic cirrhosis. He had continuous episodes by oesophageal and fundal variceal bleeding. He had splenomesoportal thrombosis associated with development caverns in the portal system. We performed a periesophagogastric devascularization, fundectomy and splenectomy. CLINIC CASE 2. A 57-year-old with portal hypertension by congenital hepatic fibrosis. She had episodes of recurrent bleeding by oesophageal, subcardial and fundal variceal. Beta-blockade and endoscopy therapy had failed. The potacaval shunt and TIPS could not achieve definitive control of variceal bleeding. She had splenomesoportal thrombosis later. Finally we performed a periesophagogastric devascularization, fundectomy and splenectomy. DISCUSSION. The endoscopic therapy is the first option by treatment of esophagogastric varices. The periesophagogastric devascularization (Sugiura procedure) came up as another option to the surgical shunt, but has important complications that increase the mortality rate. The fundectomy related to devascularization is a good alternative especially for patients with fundal variceal.