Laparoscopic Splenectomy and Esophagogastric Devascularization for Liver Cirrhosis and Portal Hypertension Is a Safe, Effective, and Minimally Invasive Operation

Yu, Haibo; Guo, Shichao; Wang, Liancai; Dong, Yadong; Tian, Guanjin; Mu, Senmao; Zhang, Huifeng; Li, Deyu; Song, Zhao

doi:10.1089/lap.2016.0032

Cited by 26 publications

(13 citation statements)

References 17 publications

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“…Although splenectomy is performed for patients with hypersplenism in some institutions[21,42], hypersplenism in most patients should be considered a laboratory abnormality that does not require treatment or further consideration[43]. However, a previous well-designed study indicated that splenectomy attenuated murine liver fibrosis[22].…”

Section: Discussionmentioning

confidence: 99%

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl₄-induced liver fibrosis

Wang¹,

Ling²,

Hong³

et al. 2016

WJG

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AIMTo investigate the diagnostic performance of liver stiffness measurement (LSM) by elastography point quantification (ElastPQ) in animal models and determine the longitudinal changes in liver stiffness by ElastPQ after splenectomy at different stages of fibrosis.METHODSLiver stiffness was measured in sixty-eight rabbits with CCl4-induced liver fibrosis at different stages and eight healthy control rabbits by ElastPQ. Liver biopsies and blood samples were obtained at scheduled time points to assess liver function and degree of fibrosis. Thirty-one rabbits with complete data that underwent splenectomy at different stages of liver fibrosis were then included for dynamic monitoring of changes in liver stiffness by ElastPQ and liver function according to blood tests.RESULTSLSM by ElastPQ was significantly correlated with histologic fibrosis stage (r = 0.85, P < 0.001). The optimal cutoff values by ElastPQ were 11.27, 14.89, and 18.21 kPa for predicting minimal fibrosis, moderate fibrosis, and cirrhosis, respectively. Longitudinal monitoring of the changes in liver stiffness by ElastPQ showed that early splenectomy (especially F1) may delay liver fibrosis progression.CONCLUSIONElastPQ is an available, convenient, objective and non-invasive technique for assessing liver stiffness in rabbits with CCl4-induced liver fibrosis. In addition, liver stiffness measurements using ElastPQ can dynamically monitor the changes in liver stiffness in rabbit models, and in patients, after splenectomy.

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Section: Discussionmentioning

confidence: 99%

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl₄-induced liver fibrosis

Wang¹,

Ling²,

Hong³

et al. 2016

WJG

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“…Advanced liver disease, such as cirrhosis, is often accompanied by hypersplenism and esophagogastric varices, which may contribute to esophageal and gastric variceal bleeding (EGVB) [ 15 , 16 ]. Furthermore, recent studies reported that splenectomy with periesophagogastric devascularization (SPD) is the optimal choice to manage hypersplenism and EGVB, with low incidence of complications and better liver function [ 17 – 24 ]. Additionally, SPD can contribute to decreased portal vein flow and increased hepatic artery flow via splenic arteriovenous disconnection [ 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Association Between Changes in Splanchnic Hemodynamics and Risk Factors of Portal Venous System Thrombosis After Splenectomy with Periesophagogastric Devascularization

Huang

Wang

2018

Med Sci Monit

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BackgroundThe purpose of this study was to investigate splanchnic hemodynamic changes and determine an optimal cutoff value for risk factors of portal venous system thrombosis (PVST) after splenectomy with periesophagogastric devascularization (SPD) in cirrhotic patients with esophageal and gastric variceal bleeding (EGVB) and portal hypertension (PH).Material/MethodsData on patients who underwent SPD were collected retrospectively from January 2013 to December 2017. Color Doppler ultrasound was performed to detect hemodynamic changes of the hepatic artery, splenic artery, splenic vein, and portal vein in included patients (n=60) and healthy volunteers (n=30). Outcomes were compared between preoperative and postoperative biochemical indicators. The cutoff values for hemodynamics were identified using receiver operating characteristic (ROC) curve analysis, and univariate and multivariate analyses of risk factors of PVST were performed.ResultsIn our series, hemodynamic indexes of splenic artery, spleen vein, and portal vein in the study group were significantly higher than that of the control group (P<0.05). Multivariate analysis revealed that the portal vein flow and the internal diameter of the portal vein were significantly correlated with PVST. The ROC analysis revealed that the cutoff points for portal vein flow and internal diameter of the splenic vein and portal vein were ≥1822.32 ml/min, ≥1.37 cm, and ≥1.56 cm, respectively.ConclusionsSPD is an effective treatment in cirrhotic patients with concomitant EGVB and PH by increasing hepatic artery flow and decreasing portal vein flow. High portal vein flow and wider diameters of the portal vein and splenic vein are important markers of PVST.

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“…At the same time, the incidence of portal hypertension has also rapidly increased[ 24 ]. The majority of patients often present with liver dysfunction, bleeding, gastrointestinal vascular disease and other serious diseases, except common clinical symptoms, including hepatosplenomegaly and ascites[ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension

Zhang¹,

Mao²,

Zhang³

et al. 2017

WJG

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AIMTo explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension, and assess the value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension.METHODSAll 67 patients with liver cirrhosis diagnosed as portal hypertension by hepatic venous pressure gradient in our hospital from June 2014 to December 2014 were enrolled into this study. The baseline information of these patients was recorded. Furthermore, 67 patients were followed-up at 20 mo after treatment, and liver and spleen shear wave velocity were measured by acoustic radiation force impulse at the 1st week, 3rd month and 9th month after treatment. Patients with favorable prognosis were assigned into the favorable prognosis group, while patients with unfavorable prognosis were assigned into the unfavorable prognosis group. The variation and difference in liver and spleen shear wave velocity in these two groups were analyzed by repeated measurement analysis of variance. Meanwhile, in order to evaluate the effect of liver and spleen shear wave velocity on the prognosis of patients with portal hypertension, Cox’s proportional hazard regression model analysis was applied. The ability of those factors in predicting the prognosis of patients with portal hypertension was calculated through receiver operating characteristic (ROC) curves.RESULTSThe liver and spleen shear wave velocity in the favorable prognosis group revealed a clear decline, while those in the unfavorable prognosis group revealed an increasing tendency at different time points. Furthermore, liver and spleen shear wave velocity was higher in the unfavorable prognosis group, compared with the favorable prognosis group; the differences were statistically significant (P < 0.05). The prognosis of patients with portal hypertension was significantly affected by spleen hardness at the 3rd month after treatment [relative risk (RR) = 3.481]. At the 9th month after treatment, the prognosis was affected by liver hardness (RR = 5.241) and spleen hardness (RR = 7.829). The differences between these two groups were statistically significant (P < 0.05). The ROC analysis revealed that the area under the curve (AUC) of spleen hardness at the 3rd month after treatment was 0.644, while the AUCs of liver and spleen hardness at the 9th month were 0.579 and 0.776, respectively. These might predict the prognosis of patients with portal hypertension.CONCLUSIONSpleen hardness at the 3rd month and liver and spleen shear wave velocity at the 9th month may be used to assess the prognosis of patients with portal hypertension. This is hoped to be used as an indicator of predicting the prognosis of patients with portal hypertension.

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Laparoscopic Splenectomy and Esophagogastric Devascularization for Liver Cirrhosis and Portal Hypertension Is a Safe, Effective, and Minimally Invasive Operation

Abstract: This meta-analysis demonstrated that laparoscopic left lateral resection is a safe and feasible option associated with a reduced overall complication rate. The current evidence suggested that it could be performed routinely in liver centers.

Cited by 26 publications

References 17 publications

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl₄-induced liver fibrosis

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl₄-induced liver fibrosis

Association Between Changes in Splanchnic Hemodynamics and Risk Factors of Portal Venous System Thrombosis After Splenectomy with Periesophagogastric Devascularization

Clinical value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension

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Laparoscopic Splenectomy and Esophagogastric Devascularization for Liver Cirrhosis and Portal Hypertension Is a Safe, Effective, and Minimally Invasive Operation

Abstract: This meta-analysis demonstrated that laparoscopic left lateral resection is a safe and feasible option associated with a reduced overall complication rate. The current evidence suggested that it could be performed routinely in liver centers.

Cited by 26 publications

References 17 publications

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl4-induced liver fibrosis

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl4-induced liver fibrosis

Association Between Changes in Splanchnic Hemodynamics and Risk Factors of Portal Venous System Thrombosis After Splenectomy with Periesophagogastric Devascularization

Clinical value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension

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Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl₄-induced liver fibrosis

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl₄-induced liver fibrosis