Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism

Kawanaka, Hirofumi; Akahoshi, Tomohiko; Kinjo, Nao; Konishi, K.; Yoshida, Daisuke; Anegawa, Go; Yamaguchi, Shohei; Uehara, Hideo; Hashimoto, Noriyuki; Tsutsumi, Norifumi; Tomikawa, Morimasa; Koushi, Kenichi; Harada, Noboru; Ikeda, Yasuharu; Korenaga, Daisuke; Takenaka, Katsuto; Maehara, Yoshihiko

doi:10.1007/s00534-009-0149-8

Cited by 52 publications

(73 citation statements)

References 28 publications

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“…Therefore, preoperative detailed knowledge of splenic vascular anatomy, volumetric data and topography is helpful for successful achievement of LS in patients with liver cirrhosis and portal hypertension. 8 Colour Doppler flow imaging (CDFI) and multi-detector-row CT (MD-CT) are common clinical methods used in the evaluation of splenic anatomy. 34,35 These imaging modalities not only discriminate and describe accurate splenic vascular anatomy, but also quantitatively estimate its magnitude and degree.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Included Studiesmentioning

confidence: 99%

“…Low-risk patients with Child-Pugh class A and B are preferred, whereas patients with class C are contraindicated. 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.…”

Section: Surgical Indicationsmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

“…Bleeding requiring re-surgery (2), pancreatic leakage (1) PVT (16) Zhou et al Uncontrollable bleeding usually occurred during the division of the splenic hilar pedicles and during the dissection of the upper pole of the spleen. 8 Although vessels within the splenic hilum can be dissected and divided individually with vascular clips in some cases, the manipulation is quite tedious and not encouraged. The splenic vessels should be controlled and divided en masse with a linear cutting stapler.…”

mentioning

confidence: 99%

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

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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Background: Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. Objectives: A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. Methods: A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. Results: Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. Conclusions: The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.

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Section: Discussionmentioning

confidence: 99%