Long-term postoperative outcomes of hypersplenism: laparoscopic versus open splenectomy secondary to liver cirrhosis

Abstract

This study investigated patients with hypersplenism secondary to liver cirrhosis. The findings showed that LS can be considered a well-disposed surgical procedure with good surgical outcomes compared with OS.

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

“…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.…”

“…Low-risk patients with Child-Pugh class A and B are preferred, whereas patients with class C are contraindicated. 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.…”

“…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.…”

“…In addition, Zhou et al, 22 Zhu et al, 24 Zheng et al 30 and Luo et al 31 investigated the effect of LS and OS procedures on liver function and found that the increases of aspartate aminotransferase, alanine aminotransferase, total bilirubin and direct bilirubin after surgery were significantly lower in LS group, which indicated minor liver function impairment.…”

“…(1) bleeding tendency (Plt < 30 ¥ 10 9 /L); (2) difficulties with therapies for HCC; (3) difficulties with induction or continuation of IFN therapy; (4) severe portal hypertension (endoscopic treatment-resistant oesophagogastric varices, PHG bleeding, and refractory ascites) Zhu et al 24 Cirrhotic patients with Plt < 30 ¥ 10 9 /L except patients with a past surgical history of left upper abdominal surgery Zhou et al 22 (1) Plt < 30 ¥ 10 9 /L or WBC < 3 ¥ 10 9 /L; (2) size 3 or 4 oesophageal varices or previous treatment for oesophageal variceal bleeding via band ligation Shigekawa et al…”