Summary
This study was aimed to explore prevention and treatment of hemorrhage during laparoscopic splenectomy plus devascularization (LSD) for portal hypertension by modified and simplified operation. From June 2012 to June 2014, LSD was performed on 138 patients with portal hypertension. The patients were allocated into two groups: earlier stage (ES) group, in which 45 patients received traditional LSD from June 2012 to Sep. 2012; later stage (LS) group, in which 93 patients underwent modified LSD from Jan. 2013 to June 2014. Perioperative variables were compared between the two groups. Laparoscopic operations were successfully performed in all but two patients in ES group who were converted to laparotomy (total conversion rate: 1.4%). There was no perioperative death or reoperation, and all patients recovered and were discharged from hospital with no serious complications in the six months of postoperative follow-up. The average time in the ES group was longer than that in the LS group (335.1 min vs. 201.3 min, P<0.05). LS group outperformed ES group in terms of blood loss (705.4 mL vs. 910.4 mL, P<0.05). The average operation time to oral diet intake after surgery (40.5 h vs. 50.3 h, P<0.05) and postoperative hospital stay (7.4 d vs. 9.0 days, P<0.05) were much less in the LS group than in the ES group. The overall complication rate (4.3 % vs. 11.1 %, P<0.05) and conversion rate (0% vs. 4.4%, P<0.05) were lower in the LS group than in the ES group. It was concluded that prevention and treatment of hemorrhage are the key points of LSD for portal hypertension. By creating a tunnel above the splenic pedicle and a tunnel behind the lower esophagus, the simplified and modified LSD can reduce hemorrhage and improve success of surgery dramatically, and splenomegaly and severe varices are not contraindications.
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Wang YD, Ye ZY, Zhu YW, et al. Laparoscopic splenectomy plus esophagogastric devascularization for the treatment of portal hypertension. Zhonghua Putong Waike Zazhi (Chinese), 2006,21(4):318–320
Huang YT. The characteristic of surgical treatment for portal hypertension in China. Zhonghua Gandan Waike Zazhi (Chinese), 2002,8(4):1–2
Zhe C, Jianwei L, Jian C, et al. Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study. J Gastrointest Surg, 2013,17(4):654–659
Xin Z, Qing GL, Ying MY. Total laparoscopic versus open splenectomy and esophagogastric devascularization in the management of portal hypertension: a comparative study, Dig Surg, 2009,26(6):499–505
Owera A, Hamade A, Bani H, et al. Laparoscopic versus open splenectomy for massive splenomegaly: a comparative study. Laparoendosc Adv Surg Tech, 2006,16(3):241–246
Bai YN, Jiang H, Prasoon P. A meta-analysis of perioperative outcomes of laparoscopic splenectomy for hematological disorders. World J Surg, 2012,36(10):2349–2358
Jankulovski N, Antović S, Petrusevska G, et al. Laparoscopic versus open splenectomy: a single center eleven-year experience. Acta Clin Croat, 2013,52(2):229–234
Ahad S, Gonczy C, Advani V, et al. True benefit or selection bias: an analysis of laparoscopic versus open splenectomy from the ACS-NSQIP. Surg Endosc, 2013,27(6):1865–1871
Wang X, Li Y, Crook N, et al. Laparoscopic splenectomy: a surgeon’s experience of 302 patients with analysis of postoperative complications. Surg Endosc, 2013,27(10):3564–3571
Orlando R, Lirussi F. Are liver cirrhosis and portal hypertension associated with an increased risk of bleeding during laparoscopy? A retrospective analysis of 1,000 consecutive cases. Surg Laparosc Endosc Percutan Tech, 2000,10(4):208–210
Ohta M, Nishizaki T, Matsumoto T, et al. Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy. J Hepatobiliary Pancreat Surg, 2005,12(6):433–437
Quah C, Ayiomamitis GD, Shah A, et al. Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary? Surg Endosc, 2011,25(1):261–265
Habermalz B, Sauerland S, Decker G, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surgery Endosc, 2008,22(4):821–848
Wu Z, Zhou J, Pankaj P, et al. Laparoscopic splenectomy for immune thrombocytopenia patients with platelet counts lower than 1 × 109/L. Int J Hematol, 2011,94(6):533–538
Ji B, Wang Y, Zhang P, et al. Anterior versus posterolateral approach for total laparoscopic splenectomy: a comparative study. Int J Med Sci, 2013,10(3):222–229
Delhey PR, Mayer S, Buerklein D, et al. Comparison of laparoscopic splenectomy in supine position with hanging-spleen technique in idiopathic thrombocytopenic purpura. Zentralbl Chir, 2011,136(2):159–163
Trelles N, Gagner M, Pomp A, et al. Laparoscopic splenectomy for massive splenomegaly: technical aspects of initial ligation of splenic artery and extraction without hand-assisted technique. Laparoendosc Adv Surg Tech, 2008,18(3):391–395
Shen YY, Cao HG, Zhou HK. Laparoscopic splenectomy for megalosplenia with preligation of splenic artery. J Laparosc Surg, 2009,14(2):344–345
Vecchio R, Marchese S, Swehli E, et al. Splenic hilum management during laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A, 2011,21(8):717–720
Yan Q, Zhu J, Zhan X, et al. Primary versus secondary splenic pedicle dissection in laparoscopic splenectomy for splenic diseases. J Am Coll Surg, 2013,216(2):266–271
Tan J, Chu Y, Tan Y, et al. Stapleless laparoscopic splenectomy with individual vessel dissection in patients with splenomegaly. World J Surg, 2013,37(10):2300–2305
Zhou J, Liu P, Yin Z, et al. Safety and cost-effectiveness analysis of laparoscopic splenectomy by secondary pedicle division using monopolar electrocautery. Hepatogastroenterology, 2013,60(126):1302–1306
Kennedy JS, Stranahan PL, Taylor KD, et al. High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc, 1998,12(6):876–878
Landman J, Kerbl K, Rehman J, et al. Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol, 2003,169(2):697–700
Kwok SY, Chung CC, Tsui KK, et al. A double-blind, randomized trial comparing Ligasure and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum, 2005,48(2):344–348
Yao HS, Wang WJ, Wang Q, et al. Randomized clinical trial of vessel sealing system(LigaSure) in esophagogastric devascularization and splenectomy in patients with portal hypertension. Am J Surg, 2011,202(1):82–90
Shabahang H, Maddah G, Tavassoli A, et al. Laparoscopic splenectomy: ligasure or clip ligation? Surg Laparosc Endosc Percutan Tech, 2012,22(2):136–138
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Wang, Wj., Tang, Y., Zhang, Y. et al. Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 35, 99–104 (2015). https://doi.org/10.1007/s11596-015-1396-3
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DOI: https://doi.org/10.1007/s11596-015-1396-3