Totally laparoscopic splenectomy plus pericardial devascularization in treatment of portal hypertension: importance of surgical teamwork and technical hints

Abstract

Objective To study the impact of surgical teamwork in totally laparoscopic splenectomy and pericardial devascularization (LSPD) in the treatment of portal hypertension, and advice on technical hints. Methods A retrospective study was conducted on the clinical features of eighty-four patients who underwent totally laparoscopic splenectomy and pericardial devascularization in the Second Affiliated Hospital of Kun Ming Medical University from January, 2014 to December, 2017. Results Totally laparoscopic procedures were performed successfully in 80 patients. The procedure was converted to hand-assisted laparoscopic splenectomy and pericardial devascularization in 3 patients because of uncontrollable bleeding. One patient who initially underwent laparoscopic cholecystectomy developed an intraoperative blood loss of 1 500 ml. The surgery was terminated and was continued one week later after stabilization of the patient. Of the 80 patients who underwent totally LSPD, the operation time ranged from 116.0 to 243.0(146.0±33.0) min. The intraoperative blood loss ranged from 60.0 to 600.0 (214.0±31.0) ml. Routine coagulation function and portal vein color Doppler ultrasound examination carried out within 3 months after surgery detected postoperative portal vein thrombosis in four patients. They responded successfully to antiplatelet and anticoagulant therapy. There were no perioperative deaths, variceal bleeding, gastrointestinal fistula and infection. Conclusions With proper surgical steps and skilled laparoscopic technique carried out by an experienced team of surgeons, totally laparoscopic splenectomy and pericardial devascularization was safe and effective in treating portal hypertension. Strict perioperative management provided a guarantee for the safe operation. Key words: Hypertension, portal; Laparoscopes; Splenectomy; Pericardia devascularization