Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;15(3):462-468.
doi: 10.5114/wiitm.2019.89655. Epub 2019 Nov 11.

Laparoscopic splenectomy via the spleen bed in combination with selective esophagogastric devascularization for patients with cirrhotic portal hypertension: a single-institution experience

Xiaopei Hao  1 , Kunfu Dai  1 , Yuting He  1 , Lianyuan Tao  1 , Haibo Yu  1
Affiliations

Laparoscopic splenectomy via the spleen bed in combination with selective esophagogastric devascularization for patients with cirrhotic portal hypertension: a single-institution experience

Xiaopei Hao et al. Wideochir Inne Tech Maloinwazyjne. 2020 Sep.

Abstract

Introduction: The safety and feasibility of laparoscopic splenectomy plus selective esophagogastric devascularization (LSSD) via the spleen bed for cirrhotic portal hypertension have not been well studied.

Aim: To assess the safety and feasibility of LSSD via the spleen bed for patients with cirrhotic portal hypertension.

Material and methods: From June 2012 to December 2017, 423 patients suffering from portal hypertension and hypersplenism with liver cirrhosis underwent surgery in our department. One hundred and sixty-seven of these patients received totally LSSD, and the others received open splenectomy and esophagogastric devascularization (OSD). The characteristics, intraoperative and postoperative details and complications of the two groups were compared.

Results: The operations were successfully performed in all patients. Intraoperative blood loss volume and blood transfusion were similar between the two groups (all p-values > 0.05). Postoperative length of hospital stay and time to oral intake were significantly shorter, but operation time was longer in the LSSD group compared with the OSD group (all p < 0.05). However, postoperative portal vein diameter was significantly smaller in the LSSD group (p < 0.001). The postoperative grade of varices was significantly lower in the LSSD group (p = 0.030). No significant differences were detected between the two groups regarding postoperative liver function, but the incidences of pancreatic leakage, pleural effusion, and wound infections were higher in the OSD group (all p < 0.05).

Conclusions: LSSD via the spleen bed is safe and feasible for liver cirrhosis and portal hypertension.

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

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Photo 1
Photo 1
Positions of trocar ports in laparoscopic splenectomy and esophagogastric devascularization. A, E – 10-mm trocar, B, C – 5-mm trocar, D – 12-mm trocar
Photo 2
Photo 2
Echelon Flex 60 was also used to resect the spleen at the splenic hilum
Photo 3
Photo 3
Laparoscopic esophagogastric devascularization with the Harmonic Scalpel and Hem-o-lock clamps
See this image and copyright information in PMC

References

    1. Lin J, Liu Q, Liang Z, et al. Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension. Videosurgery Miniinv. 2019;14:187–94. - PMC - PubMed
    1. Luigiano C, Iabichino G, Judica A, et al. Role of endoscopy in management of gastrointestinal complications of portal hypertension. World J Gastrointest Endosc. 2015;7:1–12. - PMC - PubMed
    1. Bari K, Garciatsao G. Treatment of portal hypertension. World J Gastroenterol. 2012;18:1166–75. - PMC - PubMed
    1. Hashizume M, Tanoue K, Morita M, et al. Laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices with hypersplenism. J Am Coll Surg. 1998;187:263–70. - PubMed
    1. Hong D, Cheng J, Wang Z, et al. Comparison of two laparoscopic splenectomy plus pericardial devascularization techniques for management of portal hypertension and hypersplenism. Surg Endosc. 2015;29:3819–26. - PubMed