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. 2024 Jul;54(7):807-811.
doi: 10.1007/s00595-023-02780-z. Epub 2023 Dec 6.

Hand-assisted laparoscopic splenectomy and gastropancreatic fold division: a less-invasive simplified technique of Hassab's procedure for refractory esophagogastric varices

Hitoshi Iwasaki  1   2 , Mizuki Ninomiya  3   4 , Shinji Itoh  1 , Kazuki Takeishi  2 , Hidefumi Higashi  2 , Norifumi Iseda  1 , Takuma Izumi  1 , Shohei Yoshiya  1 , Takeo Toshima  1 , Tomoharu Yoshizumi  1
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Hand-assisted laparoscopic splenectomy and gastropancreatic fold division: a less-invasive simplified technique of Hassab's procedure for refractory esophagogastric varices

Hitoshi Iwasaki et al. Surg Today. 2024 Jul.

Abstract

Some patients with refractory esophagogastric varices require surgery, such as gastric devascularization and splenectomy (Hassab's procedure). However, these patients are at risk of perioperative morbidities when undergoing devascularization to develop collateral vessels. We performed a more simplified procedure, splenectomy, and en bloc gastropancreatic fold division (GPFD) with hand-assisted laparoscopic surgery. Four patients with refractory esophagogastric varices and portal hypertension underwent splenectomy and GPFD. We reviewed patients' perioperative laboratory and morphological data, operative variables, and postoperative outcomes. Esophagogastric varices improved in 3 (75%) of the 4 patients. In one patient, esophageal varices (F1RC0) were observed 3 years after surgery, but they required no treatment and only received follow-up. Treatment with splenectomy and GPFD is not only less invasive than Hassab's procedure but also provides effective outcomes for refractory esophagogastric varices.

Keywords: Esophagogastric varices; Hassab’s procedure; Portal hypertension.

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