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Comparison of two laparoscopic splenectomy plus pericardial devascularization techniques for management of portal hypertension and hypersplenism

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Abstract

Objective

Our research was conducted to analyze the outcomes of two laparoscopic splenectomy plus pericardial devascularization (LSPD) techniques in the management of portal hypertension (PTH) and hypersplenism.

Methods

Between May 2012 and May 2013, 41 patients with PTH and hypersplenism undergoing LSPD were retrospectively analyzed. Of them, 29 patients received LSPD by LigaSure™ Vessel Sealing System (LVSS) and Endo-GIA™ universal endoscopic vascular linear staplers (Endo-GIA) (EG Group) and 12 patients received LSPD by LVSS and Hem-o-Lock (HL Group). Operating time, intraoperative blood loss, postoperative course, and hospitalization costs were compared between the two LSPD combination techniques.

Results

There were no significant differences in preoperative patient characteristics of the two groups. Significantly less operating time, intraoperative blood loss, and postoperative complications were observed in EG Group. The incidence of portal vein thrombosis was lower in the EG Group (3.4 vs. 8.3 %), as well as the incidence of pancreatic fistula (0 vs. 8.3 %). Upper gastrointestinal hemorrhage was not observed in either group. Uncontrolled bleeding warranted conversion to open surgery in one case in EG Group (conversion rate 3.4 %) and in two cases in HL Group (conversion rate 16.7 %). Two patients (16.7 %) in HL Group underwent successful emergency exploratory laparotomy due to uncontrolled intraabdominal bleeding postoperatively. No re-operation was needed in EG Group. Two patients experienced liver failure after surgery in each group. Of those, three patients were managed successfully and one patient refused further therapy. While the overall complication rate was significantly lower in EG Group (17.2 vs. 58.3 %, P < 0.05), overall hospitalization costs remained significantly higher for EG Group.

Conclusion

The results suggest that the modified Endo-GIA and LVSS technique is a safe and effective combination approach to LSPD with shorter operative time, less intraoperative blood loss, lower conversion rate to laparotomy, shorter hospital stay, better recovery, and lower postoperative complication rate compared with the Hem-o-Lock and LVSS approach. Higher hospitalization expenses associated with the Endo-GIA and LVSS approach.

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References

  1. Wright AS, Rikkers LF (2005) Current management of portal hypertension. J Gastrointest Surg 9:992–1005

    Article  PubMed  Google Scholar 

  2. He ZP (2004) Surgical treatment strategies of portal hypertension. J Hepatobiliary Surg 12:324–326

    Google Scholar 

  3. Grace ND, Groszmann RJ, Garcia-Tsao G et al (1998) Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology 28:868–880

    Article  CAS  PubMed  Google Scholar 

  4. Orozco H, Mercado MA, Chan C, Ramos-Gallard G, Gálvez-Treviño R, Salgado-Nesme N, Cisneros De-ajuria R, Anthón FJ (2002) Current role of surgery for the treatment of portal hypertension. Ann Hepatol 1:175–178

    PubMed  Google Scholar 

  5. Yang Z, Qiu F (2000) Pericardial devascularization with splenectomy for the treatment of portal hypertension. Zhong hua wai ke za zhi 38:645–648

    CAS  Google Scholar 

  6. Huang Y, Wang W, Wang J (2000) Surgical treatment of portal hypertension: 45 year experience. Zhong hua wai ke za zhi 38:85–88

    CAS  Google Scholar 

  7. Hashizume M, Tanoue K, Morita M, Ohta M, Tomikawa M, Sugimachi K (1998) Laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices with hypersplenism. J Am Coll Surg 187:263–270

    Article  CAS  PubMed  Google Scholar 

  8. Jiang XZ, Zhao SY, Luo H, Huang B, Wang CS, Chen L, Tao YJ (2009) Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension. World J Gastroenterol 15:3421–3425

    Article  PubMed Central  PubMed  Google Scholar 

  9. Vargün R, Göllü G, Fitöz S, Yagmurlu A (2007) En-bloc stapling of the splenic hilum in uncontrollable intraoperative bleeding. Minim Invasive Ther Allied Technol 16:360–362

    Article  PubMed  Google Scholar 

  10. Wang YD, Ye H, Ye ZY, Zhu YW, Xie ZJ, Zhu JH, Liu JM, Zhao T (2008) Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism. J Laparoendosc Adv Surg Tech A 18:37–41

    Article  PubMed  Google Scholar 

  11. Hong DF, Zheng XY, Peng SY, Gao M, Wu JG, Cao Q (2007) Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension due to liver cirrhosis. Zhong HuaYiXueZaZhi 87:820–822

    Google Scholar 

  12. Sun YM (2009) The controlled clinical studies of totally laparoscopic splenectomy plus pericardial devascularization compared with laparotomy. J Laparosc Surg 14:337–339

    Google Scholar 

  13. Gelmini R, Romano F, Quaranta N, Caprotti R, Tazzioli G, Colombo G, Saviano M, Uggeri F (2006) Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device. Surg Endosc 20:991–994

    Article  CAS  PubMed  Google Scholar 

  14. Gehrig T, Manzini G, Fonouni H, Golriz M, Hafezi R, Rahbari N, Brand K, Hinz U, Müller-Stich BP, Gutt CN, Mehrabi A (2013) Comparison of two different transection techniques in liver surgery—an experimental study in a porcine model. Langenbecks Arch Surg 398:909–915

    Article  CAS  PubMed  Google Scholar 

  15. Landman J, Kerbl K, Rehman J, Andreoni C, Humphrey PA, Collyer W, Olweny E, Sundaram C, Clayman RV (2003) Evaluation of a vessel sealing system, bipolar electrosurgery harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial a venous ligation in a porcine model. J Urol 169:697–700

    Article  PubMed  Google Scholar 

  16. Kwok SY, Chung CC, Tsui KK (2005) A double-blind randomized trial comparing Ligasure and Harmonic Scale hemorrhoidectomy. Dis Colon Rectum 48:344–348

    Article  CAS  PubMed  Google Scholar 

  17. El-Hakim A, Cai Y, Marcovich R (2004) Effect of Endo-GIA vascular staple size on laparoscopic vessel sealing in a porcine model. Surg Endosc 18:961–963

    Article  CAS  PubMed  Google Scholar 

  18. Hong DF (2006) Separate the control of the splenic artery and vein in laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension. ZhongHuaPuTongWaiKeZaZhi 21:706–708

    Google Scholar 

  19. Hong DF, Zheng XY, Peng SY, Gao M, Wu JG, Cao Q (2007) Laparoscopic splectomy and pericardial devascularization for the treatment of portal hypertension due to liver cirrhosis. Zhong HuaYiXueZaZhi 87:820–822

    Google Scholar 

  20. Hanash KA, Peracha AM, Al-Zahrani HM, Merdad TA, HafeezKardar A, Aslam M, Mohamed GH (2000) Radical cystectomy: minimizing operative blood loss with a ‘‘stapling technique”. Urology 56:488–491

    Article  CAS  PubMed  Google Scholar 

  21. Hsu TH, Su LM, Ratner LE, Kavoussi LR (2002) Renovascular complications of laparoscopic donor nephrectomy. Urology 60:811–815

    Article  PubMed  Google Scholar 

  22. Ji B, Liu Y, Zhang P, Wang Y, Wang G (2012) A two-step control of secondary splenic pedicles using ligasure during laparoscopic splenectomy. Int J Med Sci 9:743–747

    Article  PubMed Central  PubMed  Google Scholar 

  23. Srikanth G, Wasim MD, Sajjad A, Shetty N (2011) Single-incision laparoscopic splenectomy with innovative gastric traction suture. J Minim Access Surg 7:68–70

    PubMed Central  CAS  PubMed  Google Scholar 

  24. Hong D, Xin Y, Cai X, Peng S (2012) Application of binding pancreatogastrostomy in laparoscopic central pancreatectomy. World J Surg Oncol 10:223

    Article  PubMed  Google Scholar 

  25. Sun YW, Luo M, Chen W (2006) Portal vein thrombosis formation in patients submitted to portal hypertension operation. Wai ke li lun yu shi jian 11:198–200

    Google Scholar 

  26. Matsumoto T, Yamagami T, Terayama K, Kato T, Hirota T, Yoshimatsu R, Miura H, Ito H, Okanoue T, Nishimura T (2009) Risk factors and clinical course of portal and/or splenic vein thrombosis after partial splenic embolization. Acta Radiol 50:617–623

    Article  PubMed  Google Scholar 

  27. Dickson BC (2004) Venous thrombosis: on the history of Virchow’s triad. Univ Toronto Med J 81:166–171

    Google Scholar 

  28. Pietrabissa A, Moretto C, Antonelli G, Morelli L, Marciano E, Mosca F (2004) Thrombosis in the portal venous system after elective laparoscopic splenectomy. Surg Endosc 18:1140–1143

    Article  CAS  PubMed  Google Scholar 

  29. Ikeda M, Sekimoto M, Takiguchi S, Kubota M, Ikenaga M, Yamamoto H, Fujiwara Y, Ohue M, Yasuda T, Imamura H, Tatsuta M, Yano M, Furukawa H, Monden M (2005) High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg 241:208–216

    Article  PubMed Central  PubMed  Google Scholar 

  30. Qi X, Han G, Wu K, Fan D (2010) Anticoagulation for portal vein thrombosis in cirrhosis. Am J Med 123:e19–20; author reply e21

  31. Wang MC, Li S, Zhu JY (2004) The reason and treatment of portal vein thrombosis in patients with portal hypertension postoperation. Zhong hua wai ke za zhi 42:269–271

    Google Scholar 

  32. Amitrano L, Guardascione MA, Menchise A, Martino R, Scaglione M, Giovine S, Romano L, Balzano A (2010) Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. J Clin Gastroenterol 44:448–551

    CAS  PubMed  Google Scholar 

  33. Delgado MG, Seijo S, Yepes I, Achécar L, Catalina MV, García-Criado A, Abraldes JG, de la Peña J, Bañares R, Albillos A, Bosch J, García-Pagán JC (2012) Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 10:776–783

    Article  PubMed  Google Scholar 

  34. Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D (2000) Recent portal and mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 32:466–470

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People’s Hospital. There were not any funding sources relevant to this publication.

Disclosures

Defei Hong, Jian Cheng, Zhifei Wang, Guoliang Shen, Zhijie Xie, Weiding Wu, Yuhua Zhang, Yuanbiao Zhang and Xiaolong Liu have no conflict of interests or financial ties.

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    Authors and Affiliations

    1. Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People’s Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China

      Defei Hong, Jian Cheng, Zhifei Wang, Guoliang Shen, Zhijie Xie, Weiding Wu, Yuhua Zhang & Yuanbiao Zhang

    2. Department of General Surgery, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Institute of Micro-invasive Surgery of Zhejiang University, No. 3, Qin Chun Road, Hangzhou, 310016, China

      Xiaolong Liu

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    1. Defei Hong
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    Correspondence to Jian Cheng.

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    Defei Hong and Jian Cheng have contributed equally to this work.

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    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 29, 3819–3826 (2015). https://doi.org/10.1007/s00464-015-4147-4

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