Feasibility of splenectomy and pericardial devascularization in patients with Child-Pugh grade C cirrhosis and portal hypertension

Abstract

Objective To evaluate the feasibility of splenectomy and pericardial devascularization in patients with Child-Pugh grade C cirrhosis, portal hypertension, and severe hypersplenism or after the first gastroesophageal variceal hemorrhage (GEV bleeding). Methods From January 2010 to January 2017, the clinical data from patients with Child-Pugh grade C cirrhosis, portal hypertension with a high risk of GEV bleeding were retrospectively analyzed. These patients underwent splenectomy and pericardial devascularization at the Huashan Hospital Affiliated to the Fudan University. The safety and effectiveness of surgery, postoperative complications and mortality were further explored. Results Liver protection treatment was given before surgery to improve the liver function. Of the 32 patients who underwent splenectomy and pericardial devascularization, the operation time was (2.2±0.3) hours. The blood loss was (208.0±102.0) ml and the hospital stay after surgery was (11.8±2.8) d. Postoperative complications included fever, wound infection and ascites. One patient died of hypovolemic shock and acute renal failure. The incidence of postoperative PVT was 12.5% (4/32). The rates of GEV rebleeding at 1 year, 3 years, and 5 years after surgery were 6.3% (2/32), 6.3% (2/32), and 9.4% (3/32). The 5-year overall mortality rate was 12.5% (4/32). Conclusions In the absence of obvious surgical contraindications and with a lack of donor livers for liver transplantation, aggressive perioperative management, splenectomy and pericardial devascularization are a feasible option for patients with Child-Pugh grade C cirrhosis, portal hypertension with a high risk of GEV bleeding. Key words: Portal hypertension; Child-Pugh score, grade C; Gastroesophageal varices; Splenectomy and pericardial devascularization