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. 2024 Apr;38(4):2106-2115.
doi: 10.1007/s00464-024-10729-7. Epub 2024 Mar 4.

Prognosis of LSPD versus TIPS for the treatment of esophagogastric variceal bleeding in cirrhosis

Biao Chen #  1 , Jingxuan Wang #  2 , Weiyong Sheng  3 , Bingqing Ma  1 , Peng Xu  1 , Xing Cheng  4 , Weiyi Cheng  1 , Chengjun Cai  1 , Guoliang Wang  5 , Wenming Pan  1 , Chidan Wan  5 , Chuansheng Zheng  6 , Ping Cheng  1 , Jinxiang Zhang  7
Affiliations

Prognosis of LSPD versus TIPS for the treatment of esophagogastric variceal bleeding in cirrhosis

Biao Chen et al. Surg Endosc. 2024 Apr.

Abstract

Background: This study aimed to compare postoperative complications in patients with esophagogastric variceal bleeding (EVB) who underwent laparoscopic splenectomy combined with pericardial devascularization (LSPD) versus transjugular intrahepatic portosystemic shunt (TIPS) procedures.

Methods: A retrospective collection of medical records was conducted from January 2014 to May 2020 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The study included patients from the departments of trauma surgery, interventional radiology, and general surgery who were diagnosed with EVB caused by portal hypertension and treated with LSPD or TIPS. Follow-up data were obtained to assess the occurrence of postoperative complications in both groups.

Results: A total of 201 patients were included in the study, with 104 cases in the LSPD group and 97 cases in the TIPS group. There was no significant difference in the 1-year and 3-year post-surgery survival rates between the TIPS and LSPD groups (P = 0.669, 0.066). The 3-year survival rate of Child-Pugh B patients in the LSPD group was higher than TIPS group (P = 0.041). The LSPD group also had a significantly higher rate of freedom from rebleeding at 3-year post-surgery compared to the TIPS group (P = 0.038). Stratified analysis showed no statistically significant difference in the rebleeding rate between the two groups. Furthermore, the LSPD group had a higher rate of freedom from overt hepatic encephalopathy at 1-year and 3-year post-surgery compared to the TIPS group (P = 0.007, < 0.001). The LSPD group also had a lower rate of severe complications at 3-year post-surgery compared to the TIPS group (P = 0.020).

Conclusion: Compared to TIPS, LSPD does not increase the risk of mortality and rebleeding, while demonstrating fewer complications. In patients classified as Child-Pugh A and B, the use of LSPD for treating EVB is both safe and effective.

Keywords: Esophagogastric variceal bleeding; Laparoscopic splenectomy combined with pericardial devascularization; Portal hypertension; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

Biao Chen, Jingxuan Wang, Weiyong Sheng, Bingqing Ma, Peng Xu, Xing Cheng, Weiyi Cheng, Chengjun Cai, Guoliang Wang, Wenming Pan, Chidan Wan, Chuansheng Zheng, Ping Cheng, and Jinxiang Zhang have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection process
Fig. 2
Fig. 2
Survival curves of the two groups. Panels A and B depict the comparison of survival changes at 1 year and 3 years after surgery
Fig. 3
Fig. 3
Non-rebleeding curves of the two groups. Panels A and B depict the comparison of 1-year and 3-year non-rebleeding rates
Fig. 4
Fig. 4
Non-OHE curves comparing of the two groups. Panels A and B depict the comparison of 1-year and 3-year non-OHE rates
Fig. 5
Fig. 5
Non-severe complications curves comparing of the two groups. Panels A and B depict the comparison of 1-year and 3-year non-severe complications rates
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