Clinical effect of laparoscopic splenectomy combined with pericardial devascularization for the treatment of 310 patients with portal hypertension

Objective To investigate the clinical effect of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension. Methods The retrospective cross-sectional study was conducted. The clinical data of 310 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in the Tangdu Hospital of Fourth Military Medical University between January 2012 and June 2016 were collected. All the patients underwent laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical and postoperative situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the gastrointestinal rebleeding and postoperative survival of patients up to January 2017. Measurement data with normal distribution and skewed distribution were respectively represented as average number (range) and M (range). Results (1) Surgical and postoperative situations: all patients underwent successful operation. Twelve patients converted to open surgery due to intractable bleeding and 298 underwent totally laparoscopic splenectomy combined with pericardial devascularization. Average operation time, average volume of intraoperative blood loss, average time of gastrointestinal function recovery and average time of postoperative abdominal drainage-tube removal of 310 patients were 192.5 minutes (range, 120.0-300.0 minutes), 402.3 mL (range, 150.0-1 200.0 mL), 2.4 days (range, 1.0-4.0 days) and 4.2 days (range, 2.0-8.0 days), respectively. Among 11 of 310 patients with postoperative complications, 1 died of acute severe hemorrhage of upper digestive tract, 5 with intra-abdominal bleeding received successful hemostasis (3 undergoing reoperation and 2 undergoing conservative treatment), 2 with pleural effusion were improved by thoracentesis and drainage, 2 with pancreatic leakage and 1 with pulmonary infection were cured by conservative treatment. Other 299 patients didn′t have postoperative complications. Duration of postoperative hospital stay of 310 patients was 6.4 days (range, 5.0-9.0 days). (2) Follow-up situations: 260 of 309 patients were followed up for 6-60 months, with a median time of 26 months. During the follow-up, 1 patient died of acute portal vein thrombosis at 1 month postoperatively; 15 with gastrointestinal rebleeding and melena were cured by conservative treatment; other patients had survival. Conclusion Laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension is safe and effective. Key words: Portal hypertension; Liver cirrhosis; Splenectomy; Pericardial devascularization; Laparoscopy