Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage

Abstract

Laparoscopic splenectomy with azygoportal disconnection is a feasible, effective, and safe surgical method for the treatment of bleeding portal hypertension. Intraoperative splenic blood salvage can avoid the risk associated with allogeneic transfusion during the procedure, with an advantage of significantly increased postoperative hemoglobin levels.

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

“…1). 8,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] All were observational studies with methodological limitations (Table 1): seven non-randomized comparative studies and nine case series. The included studies can be divided into two subgroups according to surgical procedures: LS group and LSD group.…”

“…In the reviewed publications, indications for LS included bleeding tendency due to severe thrombocytopenia (platelet counts <30 ¥ 10 9 /L), 8,21,22,32 difficulties with induction or continuation of pegylated interferon (IFN) therapy due to thrombocytopenia, 8,[19][20][21]23 and difficulties with therapies for HCC due to thrombocytopenia. 8,20,21 LSD was indicated for patients with severe portal hypertension such as medical and endoscopic treatment-resistant oesophagogastric varices 9,25,[27][28][29][30][31][32] and solitary gastric varices.…”

“…[4][5][6][7] Therefore, splenectomy is still widely performed for patients with hypersplenism secondary to liver cirrhosis in China and Japan. 8,9 Haemorrhage from oesophagogastric varices is the major cause of death in cirrhotic patients with portal hypertension. The number of conventional surgery (devascularization or shunting surgery) has been substantially reduced due to the wide use of endoscopic therapy and transjugular intrahepatic portosystemic shunt and the increasing use of liver transplantation; however, it will continue to play an important role for quite a long time in China due to its large population and limited medical resources.…”

“…The number of conventional surgery (devascularization or shunting surgery) has been substantially reduced due to the wide use of endoscopic therapy and transjugular intrahepatic portosystemic shunt and the increasing use of liver transplantation; however, it will continue to play an important role for quite a long time in China due to its large population and limited medical resources. 9 Nevertheless, open splenectomy (OS), especially with devascularization (OSD), is excessively invasive in terms of blood loss and wound pain, which may aggravate liver function impairment and ascites and be associated with high rates of morbidity and mortality, especially in those with advanced cirrhosis.…”

A New Technique for Laparoscopic Splenectomy and Azygoportal Disconnection

“…These techniques include the use of cumbersome intracorporeal bags to draw massively enlarged spleens, creation of enlarged incisions to morcellate and draw splenic issues, and hand-assisted laparoscopy. [1][2][3][4][5][6][7][8][9][10] Because of the poor condition of patients with these diseases and the potential for development of many perioperative complications, incisions impairment of the techniques should be controlled. Here, we report LSD with a new technique that greatly reduces impairments.…”