Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Summary

With the rapid advancement of laparoscopic techniques, the minimally invasive benefits of laparoscopic splenectomy combined with pericardial devascularization have become increasingly evident. In this context, we present a protocol for performing laparoscopic splenectomy alongside pericardial devascularization to treat hypersplenism and esophageal variceal hemorrhage resulting from portal hypertension.

Abstract

Hypersplenism and esophageal variceal hemorrhage caused by portal hypertension are common and serious complications of decompensated cirrhosis. In recent years, with the widespread application of various therapeutic methods such as drugs, endoscopy, splenic artery embolization, transjugular intrahepatic portal shunt, and liver transplantation, the role of surgery in the treatment of portal hypertension has gradually diminished, and the indications for surgical treatment have become more strictly defined. However, according to the clinical practice in China, surgical treatment of portal hypertension still holds an important role that other treatments cannot fully replace. In fact, surgical treatment of portal hypertension is widely performed in hospitals at all levels in China, saving numerous lives. Splenectomy combined with pericardial devascularization (SPD) is the most common surgical method for treating hypersplenism and esophageal variceal hemorrhage caused by portal hypertension. Long-term clinical practice has proven that SPD is a safe and effective treatment for hypersplenism and esophageal variceal rupture and hemorrhage due to portal hypertension. With the rapid development of laparoscopic techniques, the minimally invasive advantages of laparoscopic splenectomy combined with pericardial devascularization (LSPD) have become increasingly evident. However, the successful performance of LSPD mainly depends on the skill and proficiency of the surgeon. In this context, this article presents detailed techniques for LSPD.

Introduction

China has a high number of hepatitis cases, and hepatitis patients often develop cirrhosis¹. Portal hypertension is a common complication of liver cirrhosis^2,3. The common clinical manifestations include splenomegaly, hypersplenism, peritoneal effusion, portal-systemic collateral circulation, and portal hypertensive gastroenteropathy^3,4,5. The rupture and hemorrhage of esophageal and gastric varices is the most critical complication and the leading cause of death in decompensated cirrhosis

Protocol

A total of 8 patients who underwent LSPD between October 2012 and September 2022 were included in this study. The operations were approved by the institutional review board of The First Affiliated Hospital of Jinan University. All patients provided written informed consent. The consumables and equipment required for the study are listed in the Table of Materials.

1. Inclusion criteria

1. Include patients with splenomegaly (The spleen is over 12 cm in .......

Discussion

A large proportion of people in China suffer from chronic hepatitis, which is an important factor leading to liver cirrhosis^1,2. Patients with advanced liver cirrhosis often experience portal hypertension, resulting in a series of complications, such as splenomegaly, hypersplenism, peritoneal effusion, portal-systemic collateral circulation, and portal hypertensive gastroenteropathy^3,4,

Materials

Name	Company	Catalog Number	Comments
10-mm trocar	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1-10	Sterile, ethylene oxide sterilized, disposable
12-mm trocar	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1-12	Sterile, ethylene oxide sterilized, disposable
5-mm trocar	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1-5	Sterile, ethylene oxide sterilized, disposable
Hem-o-lok	America Teleflex Medical Technology Co., LTD	544240	Sterile, ethylene oxide sterilized, disposable
Linear stapling device	America Ethicon Medical Technology Co., LTD	PSEE60A	Sterile, ethylene oxide sterilized, disposable
Pneumoperitoneum needle	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1	Sterile, ethylene oxide sterilized, disposable
Suction and irrigation tube	Tonglu Hengfeng Medical Device Co., LTD	HF6518.035	Sterile,dry heat sterilized, reusable
Ultrasounic-harmonic scalpel	Chongqing Maikewei Medical Technology Co., LTD	QUHS36S	Sterile, ethylene oxide sterilized, disposable