Hassab’s decongestion operation is an elective surgical procedure to treat esophageal varices in patients with portal hypertension as a result of cirrhosis of the liver. It was created by Dr. Mohammed Aboul-Fotouh Hassab, a professor of surgery at Alexandria University in Egypt. It has proved to be one of the most effective operations to treat bleeding varices and is used widely to treat such patients.
The approach is abdominal.
Variously developed intra- and extramural vascular structures had a relationship to the endoscopic variceal form, and communicating vessels to varices were found in 28 of the 43 primary cases treated. We then classified the esophagogastric varices into three types according to the vascular structure, such as the esophageal type, esophagogastric type, and solitary gastric type. Based on the analysis of these collateral structures, we selected the treatment as follows. In the esophageal type, which has a few inflow vessels, it is easy to eliminate the varies by obturating the inflow vessels by endoscopic injection sclerotherapy. In the esophagogastric type, which has many enlarged inflow vessels, the Hassab operation is effective in devascularizing the extramural inflow vessels, and the combination of EIS is necessary to sclerose the intramural varice. We treated a 48-year-old Japanese woman who developed both portal hypertension and pancytopenia after undergoing multiple operations for a congenital dilatation of the bile duct. She underwent a Hassab's operation in July 1994, when an occlusion of the extrahepatic portal vein, which resulted in portal hypertension, was first noted; the liver was microscopically normal. The etiology of the extrahepatic portal obstruction in our patient was most likely due to either repeated inflammation or adhesion at the hepatic hilus. Twenty patients with esophagogastric varices were examined. Before the operation, we examined the conditions of the esophagogastric varices and measured the velocity of the varices with EMDS The blood flow velocity in the largest varices was significantly higher than that in the straight varices. After the operation, the esophageal and gastric variceal blood flow velocities were markedly decreased in 15 patients. In five of the patients who received Hassab's operation, the esophageal variceal form and blood flow velocity still remained. After endoscopic injection sclerotherapy, the velocity and form were completely resolved. The non-shunting operation is effective therapy in the esophageal and gastric varices. For the control of acute gastric variceal bleeding in 4 patients, we tried performed several methods for therapy; 2 cases had endoscopic sclerotherapy, 1 had percutaneous transhepatic obliteration and 1 had partial splenic embolization. Acute bleeding was controllable in only 1 patient undergoing endoscopic sclerotherapy and subsequent elective Hassab's operation, and urgent operations were performed in other two cases. However, they died of hepatic failure several months later. In 4 of the remaining 6 patients, selective operations were performed, elective endoscopic sclerotherapy underwent in 1 and 1 had no therapy. Rebleeding was recognized in 2 patients who had had operation and endoscopic sclerotherapy, respectively. Four of these 10 patients were survived. Angiographic evaluation revealed that endoscopic sclerotherapy may be effective only in cases who have no gastrorenal shunt. In conclusion, it is thought that surgical operation.
Moreover, it may cause deterioration of gastric varices and may result in gastric hemorrhages. We would like to emphasize a combination treatment of the obliteration therapy of intramural varices by EIS and the transabdominal devascularization with splenectomy by Hassab's operation for such advanced esophagogastric varices. The purpose of this study is to develop an effective, less-painful procedure, having the fewest operational risks and a minimum number of treatment days. We tried both therapies simultaneously on four patients with esophagogastric varices. Excessive vessel damage occurred in one patient which resulted in postoperative bleeding. He subsequently fell into sepsis/DIC and eventually died on the 9th POD The three other patients are doing well and required less hospitalization time and a fewer number of additional EIS treatments than the esophageal transection group or the Hassab's operation group. Non-shunt operation included transthoracic esophageal transection in 37 patients, transabdominal esophageal transection in 3 patients, and Hassab's procedure in 6 patients. Rates of postoperative variceal eradication were: 78.4% by Sugiura's procedure; 100% by TAET; and 50% by Hassab's procedure. The cumulative rates for recurrent varices and recurrent bleeding were 3.9%, and 5.1%, respectively, at 5 years, and 8.9% and 9.8% at both 10 and 15 years. Only 3 patients required additional endoscopic injection sclerotherapy to treat recurrent varices. Although 3 patients developed upper gastrointestinal bleeding, the source of hemorrhage was esophageal varices in 1, and portal hypertensive gastropathy in 2; none of the patients died from bleeding. Actuarial survival for all patients was 87.5% at 5 years, 77.9% at 10 years, and 58.8% at 15 years. There were no deaths within the first 30 days after surgery.