Modified laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Bai, Dou‐Sheng; Qian, Jianjun; Chen, Ping; Yao, Jie; Wang, Xiaodong; Jin, Sheng‐Jie; Jiang, Guo‐Qing

doi:10.1007/s00464-013-3182-2

Cited by 31 publications

(15 citation statements)

References 17 publications

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“…After decades of clinical practice and research, the role and status of devascularization in the treatment of gastric varices bleeding with portal hypertension has been fully established. [12][13][14] Gastric fundus venous hemorrhage can occur in a relatively wide area from the fundus of the stomach to the lower esophagus. Whether the upper digestive tract bleeds after devascularization depends mainly on the blockage of blood flow.…”

Section: Discussionmentioning

confidence: 99%

Efficacy Analysis of Gastric Coronary Venous TH Glue Embolization with Splenectomy for Treating Cirrhotic Portal Hypertension

Li¹,

Wang²,

Chen³

et al. 2019

Exploratory Research and Hypothesis in Medicine

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Background and aims: To evaluate the effects of gastric coronary venous embolization with TH glue (developercontaining octyl-α-cyanoacrylate) in combination with splenectomy for the treatment of cirrhotic portal hypertension and gastroesophageal varices. Methods: From April 2002 to July 2016, 81 patients with cirrhotic portal hypertension who underwent this procedure were subject to perioperative (within 2 weeks), short-term (within 2 weeks to 1 month) and long-term (1 month thereafter) efficacy analyses. Complications, rebleeding rate, and long-term survival rate were evaluated. Results: No patients developed embolism caused by TH glue ectopia. Eleven patients experienced perioperative complications, including high esophageal expenditure blood (1%), subphrenic effusion (1%) and abdominal infection (1%), which affected one case each respectively. Pulmonary infection (2%) and portal system thrombosis (2%) affected two cases respectively. There were 4 patients who experienced ascites (5%). All patients had small amounts of melena and were healed after conservative medical treatment. The 1-, 3-, 5-and 10-year postoperative rebleeding rates were 4.9%, 8.6%, 11.1% and 18.5% respectively. The 1-, 3-, 5-and 10-year postoperative survival rates were 97.5%, 92.6%, 90.1% and 80.2% respectively. No hepatic encephalopathy occurred within 1 year after operation in any case. Conclusions: The postoperative rebleeding rate was lower than that reported in the literature and the subjects achieved good perioperative, short-term and long-term effects. The method of operation in the treatment of cirrhotic portal hypertension and gastroesophageal varices is characterized by a good safety profile, less invasiveness, rapid postoperative recovery, and a lower rebleeding rate than other devascularization procedures. Thus, it is an option that can be first considered by patients requiring emergency surgery to stop bleeding or patients with poor liver function, and even some patients with Child-Pugh grade C.

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Section: Discussionmentioning

confidence: 99%

Efficacy Analysis of Gastric Coronary Venous TH Glue Embolization with Splenectomy for Treating Cirrhotic Portal Hypertension

Li¹,

Wang²,

Chen³

et al. 2019

Exploratory Research and Hypothesis in Medicine

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“…In June 2013, Jiang et al 23 reported 10 cases. In September 2013, Bai et al 24 reported 37 cases in their controlled study. In June 2014, Cheng et al 25 reported 204 cases.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review

Jiang

Bai

Chen

et al. 2015

JSLS

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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.

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“…The procedure for laparoscopic splenectomy has been described. 10 Laparoscopic partial hepatectomy was performed as follows. First, the device for the modified Pringle maneuver, prepared as described elsewhere, 11 could be used to block the inflow of blood into the entire liver if necessary.…”

Section: Methodsmentioning

confidence: 99%

“…The entire spleen was removed through trocar D with an electromechanical morcellator (TSCS, Hangzhou, China) 10 ; spleen samples had a cylindrical appearance ( Figure 3 ). The tumor specimen was loaded into a specimen bag and removed though the enlarged umbilical incision, usually <5 cm, which was extended to a proper length along the linea alba, according to the size of the tumor.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic and Open Splenectomy and Hepatectomy

Jing-feng¹,

Bai

Jiang

et al. 2017

JSLS

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Background and Objectives:Patients undergoing synchronous open splenectomy and hepatectomy (OSH) for concurrent hepatocellular carcinoma (HCC) and hypersplenism usually have major surgical trauma caused by the long abdominal incision. Surgical procedures that contribute to rapid recovery with the least possible impairment are desired by both surgeons and patients. The objective of this study was to explore outcomes in patients treated with simultaneous laparoscopic or open splenectomy and hepatectomy for hepatocellular carcinoma (HCC) with hypersplenism.Methods:We retrospectively evaluated the treatment outcomes in 23 patients with cirrhosis, HCC, and hypersplenism, who underwent simultaneous laparoscopic splenectomy and hepatectomy (LSH; n = 12) or open splenectomy and hepatectomy (OSH; n = 11) from January 2012 through December 2015. Their perioperative variables were compared.Results:LSH was successful in all patients. There were nonsignificant similarities between the 2 groups in duration of operation, estimated blood loss, and volume of blood transfused (P > .05 each). Compared with OSH, LSH had a significantly shorter postoperative visual analog scale pain score (P < .001); shorter time to first oral intake (P < .001), passage of flatus (P < .05) and off-bed activity (P < .001); shorter postoperative duration of hospitalization (P < .001); fewer days of postoperative temperature >38.0°C (P < .01); fewer postoperative complications (P < .05); and better liver and renal function on postoperative days 7 (P < .05 each).Conclusions:Simultaneous LSH is safe for selected patients with HCC and hypersplenism associated with liver cirrhosis.

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Modified laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Abstract: The less invasive modified laparoscopic splenectomy and azygoportal disconnection group is a feasible, effective, and safe surgical procedure for liver cirrhosis patients with portal hypertensive bleeding and hypersplenism.

Cited by 31 publications

References 17 publications

Efficacy Analysis of Gastric Coronary Venous TH Glue Embolization with Splenectomy for Treating Cirrhotic Portal Hypertension

Efficacy Analysis of Gastric Coronary Venous TH Glue Embolization with Splenectomy for Treating Cirrhotic Portal Hypertension

Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review

Laparoscopic and Open Splenectomy and Hepatectomy

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