Abstract
Hassab's operation, the transabdominal decongestion with splenectomy originated by Hassab was one time prevailing for the treatment of bleeding esophago-gastric varices. The operation is, however, hardly curative because it doesn't obliterate intramural blood flow of the esophagus.
Nowadays more curative and less laborious endoscopic treatment such as endoscopic ingestion sclerotherapy (EIS) and endoscopic variceal ligation (EVL) and radiological interventions such as transjuglar intrahepatic portal systemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are regarded as the treatment of choice for esophageal varices. However, when these treatment fails, or varices are accompanied by severe hypersplenism, Hassab's operation incombination with the endoscopic treatment is still selected.
We evaluated the effect of the combination treatment in 10 patients with esophageal and/or gastric varices during the period of 1967-2004 with a group of 32 patients with varices who underwent only Hassab's treatment as a control.
During the period of a 15 year follow-up, no patients with esophageal varices who received the combination treatment bled, while 24% of patients who underwent only Hassab's operation bled. On the other hand no patient with gastric varices who underwent only Hassab's operation bled.
From these observations it is suggested that the combination treatment, Hassab's operation with EIS or EVL, is recommended for patients with esophageal varices, while uncombined Hassab's operation is recommended for those with gastric varices.
