Modified laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension.

ABSTRACT

BACKGROUND: Laparoscopic splenectomy and azygoportal disconnection has been reported safe, feasible and minimally invasive for patients with portal hypertension. We have developed an even less invasive technique, modified laparoscopic splenectomy and azygoportal disconnection, and compared outcomes of modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection in patients with portal hypertension. METHODS: We retrospectively evaluated outcomes in 107 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent modified laparoscopic splenectomy and azygoportal disconnection (n = 37) or open splenectomy and azygoportal disconnection (n = 70) between January 2010 and February 2013. Their demographic, intraoperative, and postoperative variables were compared. RESULTS: Modified laparoscopic splenectomy and azygoportal disconnection was successful in all patients, with none requiring conversion to open surgery or having significant perioperative complications. Operation time was significantly longer for modified laparoscopic splenectomy and azygoportal disconnection than open splenectomy and azygoportal disconnection (P < 0.0001), but estimated intraoperative blood loss (P = 0.0004); volume of intraoperative blood transfusion (P < 0.05); visual analog scale pain score on the first postoperative day (P < 0.0001); times to first oral intake (P < 0.0001), passage of flatus (P = 0.0004), and off-bed activity (P < 0.0001); postoperative hospital stay (P < 0.0001); postoperative days of temperature >38.0 °C (P = 0.002); white blood cell counts on postoperative days 1 (P < 0.0001) and 7 (P < 0.05) were significantly reduced in the modified laparoscopic splenectomy and azygoportal disconnection group. The percentage of patients experiencing postoperative complications was significantly lower in the modified laparoscopic splenectomy and azygoportal disconnection group than in the open splenectomy and azygoportal disconnection group (13.5 % [5/37] vs. 35.7 % [25/70], P < 0.05). CONCLUSIONS: The less invasive modified laparoscopic splenectomy and azygoportal disconnection group is a feasible, effective, and safe surgical procedure for liver cirrhosis patients with portal hypertensive bleeding and hypersplenism.