A Retrospective Cohort Study on Hassab's Surgery as a Salvage Treatment for Patients with Secondary Prophylaxis Failure for Acute Variceal Bleeding.

Objective

To investigate the safety and efficacy of Hassab's surgery as a salvage treatment for patients with secondary prophylaxis failure for acute variceal bleeding (AVB), and to determine the role of Hassab's surgery in the recompensation of cirrhosis and nutritional improvement.

Methods

This study retrospectively analyzed data of 19 patients with AVB caused by cirrhosis and portal hypertension who underwent Hassab's surgery as a salvage treatment after secondary prophylaxis failure in our center from March 2018 to June 2021. In addition, 47 patients with esophageal and gastric varices who underwent secondary prophylaxis during the same period were assigned to the control group to assess the safety and efficacy of the surgery. The objective laboratorial index and L3-SMA (the L3 skeletal muscle area, cm2, a radiological index for assessing whole-body skeletal muscle mass via CT measurement at the third lumbar vertebra level) of patients in the experimental group before and after surgery were compared to evaluate re-compensation of cirrhosis and nutritional improvement.

Results

There was no significant difference in the incidence of perioperative complications and severe complications (Clavien-Dindo grade ≥ IIIb) between the experimental group and the control group. The 5-year re-bleeding-free survival rate and the 5-year overall survival rate in the experimental group were 73.7% and 94.7%, respectively, which were not significantly different from those in the control group. In addition, compared with before surgery, the white blood cell count, platelet count, hemoglobin level, model for end-stage liver disease (MELD) score, Child-Pugh grades, prothrombin time (PT), international normalized ratio (INR), and L3-SMA significantly increased in the experimental group after surgery.

Conclusions

Hassab's surgery proves to be a safe and effective salvage treatment for patients with AVB caused by liver cirrhosis and portal hypertension who failed to undergo secondary prophylaxis. Meanwhile, it was found that after surgery, not only were hypersplenism and coagulation abnormalities relieved, but also cirrhosis was compensated and nutritional status was improved significantly. Thus, this study revealed that Hassab's surgery with safety and long-term survival effects can be used for patients with secondary prophylaxis failure for AVB in eligible patients.