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Jolivet Auguste Rakotomalala,1 Chantelli Iamblaudiot Razafindrazoto,2 Nitah Harivony Randriamifidy,2 Behoavy Mahafaly Ralaizanaka,3 Sonny Maherison,2 Domoina Harivonjy Hasina Laingonirina,2 Mialitiana Rakotomaharo,2 Anjaramalala Sitraka Rasolonjatovo,2 Mamisoa Anicet Rakotovao,4,5 Andry Lalaina Rinà Rakotozafindrabe,2 Tovo Harimanana Rabenjanahary,2 Rija Fanantenantsoa,4,5 Soloniaina Hélio Razafimahefa,3 Rado Manitrala Ramanampamonjy2 1Hepato-Gastroenterology Unit, University Hospital Mahavoky Atsimo, Mahajanga, Madagascar; 2Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar; 3Hepato-Gastroenterology Unit, University Hospital Andrainjato, Fianarantsoa, Madagascar; 4General Surgery Unit, University Hospital Andrainjato, Fianarantsoa, Madagascar; 5Visceral Surgery Unit, University Hospital Tambohobe, Fianarantsoa, MadagascarCorrespondence: Chantelli Iamblaudiot Razafindrazoto, Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar, Email iamblaudiotchantelli@yahoo.comBackground: Hepatosplenic schistosomiasis (HSS) is one of the most common causes of portal hypertension in developing countries. Variceal bleeding is the most common cause of mortality during HSS. The objective of this study was to evaluate the efficacy of splenectomy associated with endoscopic variceal ligation (EVL) compared with EVL alone in preventing variceal bleeding in patients with HSS.Methods: This was a single-center, retrospective, caseâcontrol study. Between January 2015 and December 2019, a total of 59 patients with HSS who had at least one variceal bleeding episode and received EVL with or without splenectomy were identified and stratified. In this caseâcontrol design, 22 patients had splenectomy + EVL (case group) and 37 patients had EVL alone (control group). The main endpoints were the rate of variceal rebleeding and the mortality rate between the two groups.Results: The mean age of our patients was 39.92 ± 13.4 (19â 75) years with a sex ratio of 1.8. The recurrence rate of variceal bleeding was significantly lower in the case group (splenectomy + EVL) than in the control group (EVL alone) (4.45% vs 27.2%, p = 0.041). There was no significant difference between the two groups in terms of mortality (4.54 vs 2.7%, p = 1.00).Conclusion: Splenectomy combined with EVL was effective than EVL alone in preventing variceal rebleeding in patients with HSS.Keywords: endoscopic variceal ligation, mortality, variceal bleeding, hepatosplenic schistosomiasis, splenectomy |
