Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension

Abstract

Introduction: The role of laparoscopic selective esophagogastric devascularization and splenectomy (LSEGDS) in the treatment of esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension has not been well studied.

Aim: To investigate the safety and efficacy of LSEGDS for esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension.

Material and methods: From May 2011 to December 2014, 74 patients with portal hypertension resulting from liver cirrhosis underwent surgery for gastroesophageal variceal bleeding and hypersplenism. Forty-one of these patients underwent laparoscopic esophagogastric devascularization and splenectomy (LEGDS), and the others underwent LSEGDS. A retrospective comparative analysis of clinical data was conducted between the two groups, including clinical characteristics, laboratory data, operative morbidity and mortality, and outcomes of follow-up.

Results: The operation was completed successfully in all the patients, except that conversion was required in one patient in the LEGDS group. The operating time was similar in both groups (p = 0.579). The intraoperative blood loss was lower in the LSEGDS group (p = 0.011). Postoperative complications showed no significant difference between the two groups regarding mortality rate, pleural effusion, pancreatic injury, pulmonary infection, liver dysfunction, or postoperative abdominal bleeding. Postoperative platelet counts increased significantly more in the LEGDS group than in the LSEGDS group (p = 0.004). There were no significant differences in the long-term follow-up data, such as incidence of rebleeding, portal vein thrombosis, hepatic encephalopathy and survival (p > 0.05).

Conclusions: The LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins.

Keywords: laparoscopic treatment; liver cirrhosis; portal hypertension; selective periesophagogastric devascularization; splenectomy.

Photo 1

Preserved paraesophageal vein during operation. Green arrowhead points to paraesophageal vein and white arrowhead points to esophagus

Figure 1

Survival curves of the two groups of patients

Photo 2

Preoperative CT image reconstruction of the portal vein system. White arrowhead points to esophagus; red arrowhead points to paraesophageal vein; yellow arrowhead points to perforating branch; and green arrowhead points to spleen

Photo 3

Distribution of gastric perforating branch varices at lesser curvature of stomach. Yellow arrowhead points to anterior serosa layer and green arrowhead points to posterior serosa layer

Photo 4

Postoperative CT image reconstruction of the portal vein system. White arrowhead points to esophagus; red arrowhead points to paraesophageal vein; yellow arrowhead points to disappearance of perforating branch; and green arrowhead points to removal of spleen