Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Jiang, Xiaofeng; Zhao, Shao-Yong; Hong, Luo; Huang, Bin; Wang, Changsong; Chen, Lei; Tao, Y.

doi:10.3748/wjg.15.3421

Cited by 42 publications

(34 citation statements)

References 21 publications

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“…1). 8,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] All were observational studies with methodological limitations (Table 1): seven non-randomized comparative studies and nine case series. The included studies can be divided into two subgroups according to surgical procedures: LS group and LSD group.…”

Section: Included Studiesmentioning

confidence: 99%

“…In the reviewed publications, indications for LS included bleeding tendency due to severe thrombocytopenia (platelet counts <30 ¥ 10 9 /L), 8,21,22,32 difficulties with induction or continuation of pegylated interferon (IFN) therapy due to thrombocytopenia, 8,[19][20][21]23 and difficulties with therapies for HCC due to thrombocytopenia. 8,20,21 LSD was indicated for patients with severe portal hypertension such as medical and endoscopic treatment-resistant oesophagogastric varices 9,25,[27][28][29][30][31][32] and solitary gastric varices.…”

Section: Surgical Indicationsmentioning

confidence: 99%

“…Seven studies were identified with comparisons between laparoscopic and open procedures (four comparisons of LS with OS 20,22,24,32 and four comparisons of LSD with OSD [29][30][31][32] ). The main outcome measures reported are seen in Table 5.…”

Section: Comparisons Between Laparoscopic and Open Proceduresmentioning

confidence: 99%

“…(1) recurrent sclerotherapy-resistant giant oesophageal varices; (2) recurrent rebleeding gastric varices Yamamoto et al 26 Fundal isolated gastric varices, the presence of red spots, and increasing size of the varices Hong et al 27 Medical and endoscopic treatment-resistant oesophagogastric varices Wang et al 28 Recurrent variceal bleeding Jiang et al 29 Patients with cirrhosis, bleeding portal hypertension and secondary hypersplenism Zheng et al 30 Refractory variceal bleeding and resistant to pharmacological or endoscopic treatments Luo et al 31 Recurrent variceal bleeding with Child's class A or B Wang et al 9 Recurrent variceal bleeding and resistant to medical or endoscopic treatment Ando et al 32 Haemorrhage from oesophagogastric varices HCC, hepatocellular carcinoma; HCV, hepatitis C virus; IFN, interferon; LS, laparoscopic splenectomy; LSD, laparoscopic splenectomy with devascularization; PHG, portal hypertensive gastropathy; Plt, platelet; WBC, white blood cell.…”

mentioning

confidence: 99%

“…24,29 Harmonic shears can divide 3-mm-diameter vessels and Ligasure seals vessels up to a diameter of 7 mm. As disruption of perisplenic varices or rupture of the splenic capsule carries the risk of substantial haemorrhage, it was recommended that the tissue surrounding the spleen be divided by harmonic shears or Ligasure vessel sealing equipment and blunt dissection be avoided.…”

mentioning

confidence: 99%

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Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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Background: Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. Objectives: A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. Methods: A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. Results: Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. Conclusions: The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.

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