Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension

Abstract

Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.

Application of Real‐Time Augmented Reality Laparoscopic Navigation in Splenectomy for Massive Splenomegaly

“…To address this problem, we freed and ligated the splenic arterial trunk before transection of the splenic pedicle. This manipulation can cause ischemia of the massive spleen, thereby enlarging the operative space and enhancing the safety and efficacy of splenic pedicle dissection [11]. Meanwhile, we established a retrosplenic tunnel before splenic pedicle dissection, so as to prevent injury of splenic portal vessels, increase operation space and facilitate accurate placement of Endo-GIA.…”