Laparoscopic esophagogastric devascularization for portal hypertension

Abstract

Objective To evaluate the laparoscopic splenectomy and pericardial devascularization in patients with portal hypertension. Methods In this study, 205 patients who underwent splenectomy and pericardial devascularization in the Second Hospital of Air Force Medical University between Jan 2013 and Jan 2018 were divided into 135 patients undergoing laparoscopic surgery(LSD group) and 70 patients undergoing open surgery(OSD group). Results Operation time, intraoperative blood loss, intraoperative blood infusion, time of postoperative abdominal drainage-tube removal, time of gastrointestinal function recovery and duration of hospital stay were respectively (150±37)min, (223±129)ml, (91±138)ml, (4.0±1.0)d, (33±9)h, (5.6±1.0)d in the LSD group, (183±42)min, (346±131)ml, (214±182)ml, (5.5±1.3)d, (42±14)h, (7.5±1.4)d in the OSD group, with statistically significant differences between groups(t=-2.203, -4.980, -2.830, -5.553, -2.307, -6.635, all P<0.05). The main complications included pancreatic fistula, intra-abdominal bleeding, intra-abdominal infection, pulmonary infection, refractory ascites, portal vein system thrombosis and incision infection, and there were respectively 0, 1, 2, 2, 3, 13, 0 in the LSD group and 3, 4, 6, 6, 7, 14, 3 in the OSD group, with statistically significant differences between groups (χ2=5.872, 4.792, 6.179, 6.179, 6.010, 4.335, 5.872, all P<0.05). All the 205 patients received follow-up for a median time of 38 months(12-72 months). Gastroscopy showed improvement of esophageal and gastric varices in postoperative 6 months. Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension is safe, feasible and effective. Key words: Hypertension, portal; Laparoscopy; Splenectomy