Primary Versus Secondary Splenic Pedicle Dissection in Laparoscopic Splenectomy for Splenic Diseases

Qu, Yan; Zhu, Jinhui; Zhan, Xiaoli; Weng, Wei-Hong; Wu, Wanbo; Shen, Deyan; Yu, Kai; Wang, Yuedong

doi:10.1016/j.jamcollsurg.2012.10.019

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…Yan et al in 2012 showed that the secondary splenic pedicle dissection is a valuable technique for the minimally invasive splenectomies, even in patients with splenomegaly. It can also decrease the incidence of splenic fever and pancreatic leakage [11]. In the present series, a spleen‐preserving surgery was possible for the distributed vascular type of the splenic hilum, even if the size of the cyst was bigger than 10 cm.…”

Section: Discussionmentioning

confidence: 77%

“…This configuration impedes the primary and the secondary dissection of the splenic pedicle. Thus, dissection and ligation of each branch separately is difficult, so they are easily torn and injured [11]. In this case, even if the size or location of the cyst is favorable, a spleen-preserving surgery is virtually impossible.…”

Section: Discussionmentioning

confidence: 99%

“…In the magistral or bundled supply, the main splenic artery is long and divides near the hilum. The dissection and ligation of each branch is difficult, making a splenic parenchyma-preserving surgery rather unlikely [11].…”

Section: Introductionmentioning

confidence: 99%

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Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

2018

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

2018

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“…The maneuver using Endo GIA to staple and mutilate the splenic pedicle directly is called the primary pedicle dissection, while the secondary pedicle dissection refers to separation and ligation of second branches of the splenic pedicle individually [20] . Currently there are 3 ways to manipulate the splenic pedicle in total laparoscopic surgeries: (1) Ligating the second branches of the splenic pedicle with clips or threads of silk: A study reported by Tan et al [21,22] has introduced a method applying double ligation of proximal splenic vessel with a thread of silk and occlusion of distal part with a titanium clip, and they proved that it is feasible, effective and cheap; (2) manipulating the splenic pedicle with Endo GIA: it is simple, safe and effective, which make it the favorite method chosen by most doctors at home and abroad, though more expensive [20] ; (3) processing the splenic pedicle with LigaSure vessel-sealing equipment: it has been developed for the safe closure of arteries up to 7 mm in diameter [23] . But the data for venous closure are rare, some study stated that it can be used to close veins up to 12 mm in diameter [24] and can treat grades 3 and 4 of hemorrhoids [25] .…”

Section: Discussionmentioning

confidence: 99%

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Wang

Tang

Zhang

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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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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Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension

Liu

Zhao

Tang

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.

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Primary Versus Secondary Splenic Pedicle Dissection in Laparoscopic Splenectomy for Splenic Diseases

Cited by 8 publications

References 27 publications

Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension

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