Totally laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension

Objective: To investigate the technique and clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension. Methods: The clinical data of 135 patients of portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization between Jan. 2012 and Apr. 2013 were retrospectively analyzed. Results: Laparoscopic splenectomy combined with pericardial devascularization was successfully performed for 129 patients. 6 cases were converted to open surgery due to intraoperative intractable bleeding. The surgery time was 15-270 min,with the average of( 195. 9 ±24. 4) min. The blood loss was 150-1 000 ml,average( 346. 1 ±112. 2) ml. The postoperative hospital stay was 5-9 d,average( 6. 3 ± 0. 6) d. Two cases underwent the second operation because of the intra-abdominal hemorrhage after the first one. 1 case of the intra-abdominal hemorrhage underwent non-operative treatment. Other postoperative complications included pancreatic leakage in 1case,pneumonia in 1 case,pleural effusion in 1 case. And all were cured by non-operative treatments. No upper gastrointestinal rebleeding occurred during follow-up period of 3 to 18 months. Conclusions: The laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension is a safe and feasible procedure. It has the advantages of less invasion,quicker recovery and better effect. It is particularly important to carefully select patients preoperatively,fix operation group,flexibly deal with any case according to the surgical experience.