Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review

Abstract

Background and Objectives:Given the technical difficulty of laparoscopic splenectomy and azygoportal disconnection (LSD), data are limited that compare the laparoscopic to the open procedure. As the technique becomes more widespread, questions regarding its safety, feasibility, and reproducibility must be addressed. This review assesses the current status of LSD.Methods:We conducted our literature review with a search of the PubMed database. All published series of 5 or more laparoscopic splenectomy and azygoportal disconnection procedures were examined. The demographic, intraoperative, and postoperative data analyzed included number of ports, conversion rate, operative duration, estimated intraoperative blood loss, postoperative hospital stay, and complications.Results:Fifteen articles met the review criteria. Of 412 laparoscopic procedures, traditional laparoscopic splenectomy and azygoportal disconnection (TLSD) was used in 322 patients (78.2%), a modified laparoscopic procedure (MLSD) in 79 (19.2%), and a single-incision laparoscopic procedure (SLSD) in 11 (2.7%). Compared with the traditional and single-incision laparoscopic procedures, the MLSD procedure was associated with shorter operative duration and less blood loss. Furthermore, although the incidence of postoperative portal vein system thrombosis was higher in the laparoscopic than in the open splenectomy with azygoportal disconnection (OSD) procedure, the LSD procedure was associated with less pulmonary infection and pleural effusion and fewer incisional and overall complications than the open procedure. The rate of conversion to an open procedure was 5.4%.Conclusions:LSD is feasible and safe for selected patients when performed by an expert laparoscopic surgeon. It has perioperative advantages over OSD, but studies with longer follow-up periods and larger samples of patients are needed.

Elective Splenectomy Combined with Modified Hassab’s or Sugiura Procedure for Portal Hypertension in Decompensated Cirrhosis

“…Under this situation, additional nonshunting surgery was considered by our center to ensure an extensive devascularization including pericardial and upper stomach vascular types, which could be hardly completed by other techniques. Because of the development of less invasion concept, modified laparoscopic nonshunting surgery has been introducing and playing new roles in the management of portal hypertension [24, 25]. Although invasion is less, the specific surgery scope and method do not have essential difference between open and laparoscopic surgery other than surgery-related complications [25].…”

“…Because of the development of less invasion concept, modified laparoscopic nonshunting surgery has been introducing and playing new roles in the management of portal hypertension [24, 25]. Although invasion is less, the specific surgery scope and method do not have essential difference between open and laparoscopic surgery other than surgery-related complications [25]. Dr. Wang et al retrospectively investigated the efficacy of the modified Sugiura procedure and Hassab procedure for treatment of rebleeding due to portal hypertension after endoscopic variceal ligation and found the modified Sugiura procedure is more effective than the Hassab procedure for the treatment of rebleeding after endoscopic variceal ligation [26].…”

Surgical Tactics for Failure of Stapler Esofago-Esofagoanastomosis During Esophagastric Devascularization

“…Это в свою очередь способствует регенерации печени со значительным улучшением результатов печеночных тестов и клиренс теста с индоциановым зеленым на 15 минуте (ICG-R15) [20,21,22]. В 1964 г. Hassab описал технику спленэктомии с перикардиальной деваскуляризацией для лечения пациентов с пищеводным варикозом и гиперспленизмом [23].…”

Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

“…Gastroesophageal variceal bleeding is the leading cause of mortality in cirrhotic patients with portal hypertension [4]. In 1964, the Hassab procedure, also termed as splenectomy with azygoportal disconnection, was initially used for treating esophageal varices and hypersplenism [5].…”

“…Patients with chronic hepatitis B or C virus infection and chronic alcohol consumption may develop cirrhosis [ 1 , 2 ], which can contribute to secondary portal hypertension and hypersplenism [ 3 ]. Gastroesophageal variceal bleeding is the leading cause of mortality in cirrhotic patients with portal hypertension [ 4 ]. In 1964, the Hassab procedure, also termed as splenectomy with azygoportal disconnection, was initially used for treating esophageal varices and hypersplenism [ 5 ].…”