Laparoscopic Splenectomy and Esophagogastric Devascularization Is a Safe, Effective, Minimally Invasive Alternative for the Treatment of Portal Hypertension With Refractory Variceal Bleeding

Abstract

Open splenectomy and esophagogastric devascularization (OSED) is a typical surgery for portal hypertension. Because of the high morbidity associated with it, it is desirable to develop a minimally invasive alternative. To investigate the safety and effect of laparoscopic splenectomy and esophagogastric devascularization (LSED), we performed LSED for 24 patients suffering from portal hypertension with refractory variceal bleeding while conducting OSED for 30 patients. The perioperative data and follow-up results were analyzed. Operation times were similar in both groups. Less intraoperative blood and faster return of gastrointestinal function were found in the LSED group. The LSED group had lower levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin after surgery. In both groups, the levels of platelet count, white blood cell count, or hemoglobin were increased after operation dramatically. During the follow-up period (range = 3-36 months), no patient had recurrent hypersplenism or variceal bleeding. Hence, LSED is a safe and minimally invasive intervention for portal hypertension with refractory variceal bleeding.

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

“…In addition, Zhou et al, 22 Zhu et al, 24 Zheng et al 30 and Luo et al 31 investigated the effect of LS and OS procedures on liver function and found that the increases of aspartate aminotransferase, alanine aminotransferase, total bilirubin and direct bilirubin after surgery were significantly lower in LS group, which indicated minor liver function impairment.…”

“…Seven studies were identified with comparisons between laparoscopic and open procedures (four comparisons of LS with OS 20,22,24,32 and four comparisons of LSD with OSD [29][30][31][32] ). The main outcome measures reported are seen in Table 5.…”

“…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.…”

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.…”