Hand-assisted Laparoscopic Splenectomy Research Articles

Spontaneous clearance of serum HCV-RNA after splenectomy in a patient with HCV-related liver cirrhosis and portal hypertension: a case report

BackgroundSpontaneous clearance of chronic hepatitis C virus (HCV) is rare in adults. A T-lymphocyte response is thought to be involved in HCV-RNA clearance. Splenectomy reportedly has a beneficial effect on T cell immune function in patients with cirrhosis. To the best of our knowledge, the present report is the first to describe spontaneous clearance of serum HCV-RNA within 1 year after splenectomy in a patient with cirrhosis.Case presentationA 55-year-old man with HCV cirrhosis was transferred to our institution with advanced pancytopenia, splenomegaly, and gastric varices. He had a 1-year history of ascites, edema, and general fatigue. The patient had a Child–Pugh score of 8 and serological type 1 HCV; the HCV-RNA level was 4.7 log IU/mL. Contrast-enhanced computed tomography showed gastric varices and marked splenomegaly (estimated spleen volume of 2175 mL). Esophagogastroduodenoscopy revealed enlarged gastric varices with no red color sign, and the varices were larger than those 1 year prior. He was diagnosed with decompensated HCV-related liver cirrhosis and portal hypertension. We considered direct-acting antiviral (DAA) therapy; however, DAA therapy was not approved in Japan for patients with decompensated cirrhosis at that time. Hand-assisted laparoscopic splenectomy was performed to improve the worsening portal hypertension. Further, we planned the initiation of DAA therapy after surgery, when such therapy would become available. DAA therapy was approved 1 year after splenectomy. At that time, we measured the HCV-RNA level before the initiation of DAA therapy; unexpectedly, however, serum HCV-RNA was not detectable, and the virus continued to disappear during the following 4 years. His liver function (total bilirubin, albumin, and prothrombin time) and pancytopenia improved during the 5 years postoperatively. The serum aspartate and alanine aminotransferase levels normalized between 1 and 5 years postoperatively. Esophagogastroduodenoscopy showed no change in the gastric varices during the 5 years after surgery. The patient remained asymptomatic and continued to do well.ConclusionsWe have presented a case of spontaneous clearance of HCV-RNA after splenectomy in a patient with cirrhosis and portal hypertension. Splenectomy may be associated with disappearance of HCV-RNA based on previous reports. More cases should be accumulated and evaluated.

Hand-assisted laparoscopic splenectomy and gastropancreatic fold division: a less-invasive simplified technique of Hassab's procedure for refractory esophagogastric varices.

Some patients with refractory esophagogastric varices require surgery, such as gastric devascularization and splenectomy (Hassab's procedure). However, these patients are at risk of perioperative morbidities when undergoing devascularization to develop collateral vessels. We performed a more simplified procedure, splenectomy, and en bloc gastropancreatic fold division (GPFD) with hand-assisted laparoscopic surgery. Four patients with refractory esophagogastric varices and portal hypertension underwent splenectomy and GPFD. We reviewed patients' perioperative laboratory and morphological data, operative variables, and postoperative outcomes. Esophagogastric varices improved in 3 (75%) of the 4 patients. In one patient, esophageal varices (F1RC0) were observed 3years after surgery, but they required no treatment and only received follow-up. Treatment with splenectomy and GPFD is not only less invasive than Hassab's procedure but also provides effective outcomes for refractory esophagogastric varices.

OGBN P13 Laparoscopic splenectomy for massive splenomegaly: Is it feasible?

Abstract Background Laparoscopy has high credibility in the treatment of normal sized and mildly enlarged spleens. However, there is lack of evidence for its safety for cases with massive splenomegaly. EAES defined massive splenomegaly by maximum splenic diameter exceeding 20 cm. It recommended hand assisted laparoscopic splenectomy (HALS) or open surgery as a treatment for such cases. In this video, we demonstrated the feasibility of the use of laparoscopy in cases with massive splenomegaly with favourable outcomes. Methods We describe a video for a 36 years old female patient who is known Kikuchi syndrome. She had massive splenomegaly which reached 25 cm in its maximum length. Patient was in right lateral position. Camera port was located left to the umbilicus, another 10 mm port at left midclavicular line and two 5 mm ports were used (one at epigastrium and assistant port at left anterior axillary line). The video demonstrates the steps of laparoscopic splenectomy with the challenges of the huge size of the spleen. Specimen was taken through patient’s old caesarean scar (Pfannenstiel incision). Results Patient had CT scan on day 2 for raised inflammatory markers, which showed small collection at splenic bed which was treated conservatively. Patient was discharged on day 5 postoperatively after removal of surgical drain. Clinical review after 4 weeks post discharge didn’t show any clinical concerns. Conclusions Using a stepwise laparoscopic approach is feasible and safe for massive splenomegaly cases. Refining the selection criteria for laparoscopic versus open or HALS splenectomy should be revised with less consideration to the size of spleen as a limiting factor.

Hand-Assisted Laparoscopic Splenectomy with Temporary Splenic Artery Occlusion in Pediatric Patients: The Experience in a Chinese Tertiary Children's Hospital.

Background: The hand-assisted laparoscopic splenectomy (HALS) approach overcomes the difficulties experienced with conventional laparoscopic splenectomy (LS) with added advantages. In this study, we compared the HALS technique with standard LS based on the feasibility and intermediate postoperative outcomes in pediatric patients. Methods: We retrospectively investigated pediatric patients who underwent HALS or LS from October 2013 to May 2021 at the Children's Hospital, Chongqing Medical University. Potential parameters related to HALS or LS were explored, and the intermediate-term clinical outcomes were compared between the two groups. The quality of life and splenic regrowth data were followed up routinely for 12 months after the operation. Results: In total, 39 patients underwent splenectomy (11 for HALS and 28 for LS) and were eligible for this research. Patients who underwent HALS had a greater proportion of focal benign splenic lesions (P < .001) and partial splenectomy (P < .001). The HALS operative time was reduced compared with LS (P = .032). No operation conversion was noted in the HALS group, whereas 4 (14.3%) cases were converted to an open operation (P = .249). For partial splenectomies, favorable outcomes with HALS, including short operative time (P = .001) and reduced blood loss (P = .014), were noted compared with LS. No postoperative mortality was observed. During the follow-up period, a good quality of life and splenic regrowth were noted for most of the patients. Conclusions: Although another incision is necessary, HALS confers the advantages of a minimally invasive technique to manage the fragile spleen, especially in pediatric patients requiring partial splenectomy.

Successful treatment with laparoscopic surgery and sequential multikinase inhibitor therapy for hepatocellular carcinoma: A case report

BACKGROUNDHepatocellular carcinoma (HCC) with massive portal vein tumor thrombosis (PVTT) and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.CASE SUMMARYA 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization plus sorafenib for recurrence. Four years after initial hepatectomy, she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites. Her liver function was Child-Pugh B (8), and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were elevated up to 46.291 mAU/mL. Since initial treatment with regorafenib for three months was unsuccessful, the patient was administered lenvatinib. Ten months post-treatment, there was no contrast enhancement of PVTT or splenic metastasis. Chemotherapy was discontinued due to severe diarrhea. Afterward, splenic metastasis became viable, and PIVKA II increased. Therefore, hand-assisted laparoscopic splenectomy was performed. She experienced no clinical recurrence 14 mo after resection.CONCLUSIONConversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.

Successful Multidisciplinary Treatment with Laparoscopic Surgery and Sequential Multikinase Inhibitor Therapy for Multivisceral Recurrence of Hepatocellular Carcinoma

Background: Hepatocellular carcinoma with massive portal vein tumor thrombosis and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary treatment of sequential multikinase inhibitor and laparoscopic surgery for multivisceral recurrence. Case presentation: A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with liver tumor. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization and sorafenib for recurrence. Four years after the initial hepatectomy, she was found to have a 43 mm mass in the spleen and a tumor thrombus that involved the right anterior portal branches down to the main trunk with severe ascites. Her liver function was Child-Pugh B (8), and PIVKA II levels were elevated up to 46,291 mAU/mL. The patient was initially treated with regorafenib but experienced disease progression 3 months later with a maximum PIVKA II value of 129,815 mAU/mL. The patient was then administered lenvatinib. Eighteen months after the treatment, there was no contrast enhancement of the portal vein tumor thrombosis and splenic metastasis. This chemotherapy was discontinued because of grade 3 diarrhea. Afterward, splenic metastasis increased again with the rise in PIVKA II. Therefore, hand-assisted laparoscopic splenectomy was performed. The patient was discharged 10 days postoperatively. There was no clinical evidence of recurrence 14 months after resection. Conclusion: Conversion surgery after successful multikinase inhibitor treatment is considered an effective treatment option for advanced HCC.

Comparative Study between Anterior and Lateral Approaches of Laparoscopic Splenectomy

Abstract Background: The primary basis of treatment for ITP and many hematological disorders was splenectomy. There are many approaches and techniques that have evolved for splenec-tomy. Reports of laparoscopic splenectomy began appearing in the literature in 1991 and 1992. Over time it has become the standard for elective splenectomy for both benign and malignant indications although open splenectomy remains perfectly acceptable for all indications as well. Laparoscopic splenectomy developed many techniques and approaches through last years, examples of these are anterior approach laparoscopic splenectomy, lateral approach laparoscopic splenectomy, single port laparoscopic splenectomy, hand assisted laparoscopic splenectomy (HALS). Aim of Study: The goal of this study is to compare lapar-oscopic splenectomy anterior and lateral approaches, including operative time, blood loss, surgical complications, conversion to open surgery, postoperative morbidity, postoperative length of stay, number of trocars used and blood transfusion require-ments in each approach. Materials and Methods: The present study was a rand-omized controlled prospective study with 40 patients. Indicated for splenectomy at El-Demerdash Hospital between 2018 and 2020, splenectomy was done by the same surgical team. The 40 cases in our sample were obtained from Ambulatory Clinics in University Hospitals in Ain-Shams. The closed envelope system split the patients into two classes: Group 1 including 20 patients underwent laparoscopic splenectomy using anterior approach, group 2 including 20 patients underwent laparoscopic splenectomy using lateral approach. The inclusion criteria were all adult patients indicated for surgery, fit for anesthesia and consented to participate in the study, aged between 18 to 60 years with a diagnosis of: Hematological disorder (Idio-pathic thrombocytopenic purpura ITP, Thrombotic Thrombo-cytopenic Purpura TTP, chronic hemolytic anemia except sickle cell disease), hydatid cyst, splenic tumor; as lymphoma, felty syndrome and sarcoidosis. We excluded patients with bleeding tendency due to causes other than ITP, patients with previous upper laparotomies, patients with generalized diseases that contra-indicates laparoscopic maneuvers, patients with huge splenomegaly with longitudinal axis more than 20cm and pregnancy.Results: In the present study; there were statistically important ties between the types of approach used and both operative time and number of ports., we found that the lateral approach had a shorter operative time; as well as, the number of ports was less in lateral approach. On the contrary there was no statistically significant difference between two types of approach in terms of age, body mass index (BMI), gender, indication of surgery, complete blood count (CBC) findings, spleen size, blood loss, vascular or visceral injury, conversion to open surgery, hospital stay and post-operative complications (chest infection, wound infection, pancreatic leak and acute gastric dilatation). Conclusion: We find that for laparoscopic splenectomy, the lateral approach has a greater intraoperative benefit than the anterior approach. The lateral solution was connected to much shorter operative times and a smaller number of ports.

Splenectomy

Laparoscopic splenectomy has become an established standard of care in the management of surgical diseases of the spleen, except in the hemodynamically unstable trauma patient requiring splenectomy. Although adoption of minimally invasive splenectomy has led to a gradual decrease in the indications for open splenectomy, both procedures are still essential components of spleen surgery. This review describes the indications and contraindications for procedure, preoperative preparation and consent, operative anatomy and technique, and long-term follow-up. Tables review the clinical indications for splenectomy, classification of splenectomy, a comparison of laparoscopic versus open postsplenectomy outcomes, indications and contraindications for partial splenectomy, and reported incidences of postoperative outcomes and complications after splenectomy. Figures depict splenomegaly, the American Society of Hematology 2011 evidence-based practice guidelines for management of primary idiopathic thrombocytopenic purpura in children and adults, a splenic mass, a splenic cyst, massive splenomegaly, laparoscopic splenectomy, the 2014 Centers for Disease Control and Prevention recommendations for adult and pediatric splenectomy vaccination, splenic artery embolization, various laparoscopic approaches to splenectomy, splenic vascularization, division of splenic artery branches, suspensory ligaments of the spleen, laparoscopic exposure and transection of splenic hilum, retrieval bags and related procedures, open splenectomy, stapling, and laparoscopic partial splenectomy. Videos demonstrate purely laparoscopic splenectomy and hand-assisted laparoscopic splenectomy. This review contains 26 figures, 5 tables, 2 videos, and 111 references.

Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report

BackgroundLiver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver.Case presentationA 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year.ConclusionsOur patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.

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

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

Hand-assisted Laparoscopic Splenectomy Advantages Over Complete Laparoscopic Splenectomy For Splenomegaly.

Laparoscopic splenectomy (LS) is generally applied for splenectomy, However, it also brings some technical challenges, especially for splenomegaly. Hand-assisted laparoscopic splenectomy (HALS) can help to overcome these drawbacks while maintaining the superiority of LS. This study was aimed to evaluate the efficacy and advantage of HALS for splenomegaly. Between January 2014 and November 2017, 91 patients with splenomegaly in 2 surgical centers were randomly assigned to either HALS (n=45) or LS (n=46). The patients' characteristics, intraoperative details, and the postoperative outcomes in both groups were compared. Baseline features (sex, age, main diameter, Child-Pugh grade) of both groups had no significant difference (P<0.05). Compared with LS group, the HALS group operation time (141±46 vs. 172±43 min; P=0.001) was shorter, intraoperative blood loss [215 (122.332) vs. 230 (130.740) mL; P=0.026], hospital expenses (5.5±1.5 vs. 6.4±2.4 WanRMB; P=0.022), and conversion rate (1/45 vs. 9/46; P=0.015) were lower. However, there was no significant difference for hospital stay (6.4±2.8 vs. 6.7±3.0 d; P=0.662) and complications (15/45 vs. 12/46; P=0.893) between the 2 groups. In addition, there were no significant differences in postoperative white blood cell (10.6±2.9 vs. 10.9±3.5; P=0.747), AST [61 (47.94) vs. 57 (37.86) U/L; P=0.513], and ALT [68 (54.120) vs. 55 (36.99) U/L; P=0.302] levels. HALS can maximize the benefits for patients, while maintaining the advantages of LS and open splenectomy. It is the ideal surgical treatment for splenomegaly.

Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A meta-analysis.

BACKGROUNDHand-assisted laparoscopic splenectomy (HALS) can help overcome the drawbacks of laparoscopic splenectomy (LS) while maintaining its advantages.AIMTo evaluate the efficacy and advantages of HALS for splenomegaly.METHODSThe relevant literature was reviewed using the PubMed, EMBASE, Cochrane, Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from 16 trials who met the inclusion criteria were selected.RESULTSIn pure splenectomy, blood loss volume (P < 0.001) and conversion rate (P = 0.008) were significantly lower in the HALS group than in the LS group. Conversely, for splenomegaly, the operative time (P = 0.04) was shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach (DUS), the operative time (P = 0.04) was significantly shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.CONCLUSIONHALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.

Splenectomy in Gaucher Disease: A Call for Minimally Invasive Surgery.

The objective of this article was to demonstrate that Gaucher disease (GD) patients with refractory hypersplenism and massive splenomegaly may successfully undergo hand-assisted laparoscopic splenectomy (HALS). This was a retrospective audit conducted at the Gaucher clinic at a national referral center over a 10-year period. This study included 8 GD patients who underwent hand-assisted or conventional laparoscopic splenectomy for massive or complicated splenomegaly between the years 2007 and 2017. Seven patients underwent an elective HALS procedure because of refractory hypersplenism, whereas 1 patient underwent an urgent conventional laparoscopic splenectomy because of torsion of a wandering spleen. Only 1 patient required conversion to open surgery because of multiple adhesions from a previous partial splenectomy. The mean weight of the removed spleens was 2373 g (range, 480 to 4900 g), mean craniocaudal length of the removed spleens was 25 cm (range, 20 to 33.5 cm), and mean operating time was 150 minutes (range, 96 to 280 min). Postoperative complications were limited to 2 patients and included thrombosis of the splenic vein stump in 1 patient, and propagation of a preoperative splenic vein thrombus to the portal system, as well as an accumulation of an intra-abdominal hematoma in another patient. There was no mortality. Mean length of hospital stay was 5 days (range, 2 to 11 d). HALS for GD patients with refractory hypersplenism and massive splenomegaly is safe and feasible in experienced hands.

Video presentation: hand-assisted laparoscopic distal pancreatectomy and splenectomy for disconnected pancreatic duct syndrome

Background: Disconnected pancreatic duct syndrome is a condition resulting from necrosis of the pancreatic duct which causes discontinuity between viable secreting distal pancreatic parenchyma and the gastrointestinal tract. The persistent leakage of pancreatic fluid leads to recurrent collections, pancreatitis, and pseudocyst formation. This condition is most often caused by necrotizing pancreatitis and the diagnosis is often delayed, resulting in a prolonged, complicated course. The first line therapy is usually endoscopic stenting or drainage with surgery reserved for those patients whose symptoms do not resolve. Methods: We present the case of a 34-year old female with disconnected pancreatic duct syndrome whose treatment course is representative of the change in management of pancreatic pseudocysts and disconnected pancreatic ducts. Results: A decade ago, she had her initial episode of pancreatitis that resulted in a persistent pseudocyst which was surgically drained, as was frequently the treatment of choice at that time. Years later, she had recurrent pancreatitis, another pseudocyst, and was diagnosed with disconnected pancreatic duct syndrome. Endoscopic techniques failed to resolve her symptoms. She eventually required surgery, which was particularly challenging due to the recurrent bouts of pancreatitis, her previous surgical cyst-enterostomy, the endoscopic cyst- gastrostomy with an indwelling metal stent, and the pancreatic duct stent which had been placed to try to bridge the disconnected duct and drain the distal pancreas. Conclusion: Despite these challenges, the surgery was successfully completed using a hand- assisted laparoscopic technique to resect the distal disconnected pancreas.

Hand-assisted laparoscopic Hassab\u2019s procedure for esophagogastric varices with portal hypertension

BackgroundLaparoscopic surgery for patients with portal hypertension is considered to be contraindicated because of the high risk of massive intraoperative hemorrhaging. However, recent reports have shown hand-assisted laparoscopic surgery for devascularization and splenectomy to be a safe and effective method of treating esophagogastric varices with portal hypertension. The aim of this study is to evaluate the efficacy of hand-assisted laparoscopic devascularization and splenectomy (HALS Hassab’s procedure) for the treatment of esophagogastric varices with portal hypertension.Case presentationFrom 2009 to 2016, seven patients with esophagogastric varices with portal hypertension were treated with hand-assisted laparoscopic devascularization and splenectomy in our institute. Four men and three women with a median age of 61 years (range 35–71) were enrolled in this series. We retrospectively reviewed the medical records for the perioperative variables, postoperative mortality and morbidity, and postoperative outcomes of esophagogastric varices. The median operative time was 455 (range 310–671) min. The median intraoperative blood loss was 695 (range 15–2395) ml. The median weight of removed spleen was 507 (range 242–1835) g. The conversion rate to open surgery was 0%. The median postoperative hospital stay was 21 (range 13–81) days. During a median 21 (range 3–43) months of follow-up, the mortality rate was 0%. Four postoperative complications (massive ascites, enteritis, intra-abdominal abscess, and intestinal ulcer) were observed in two patients. Those complications were treated successfully without re-operation. Esophagogastric varices in all patients disappeared or improved. Bleeding from esophagogastric varices was not observed during the follow-up period.ConclusionAlthough our data are preliminary, hand-assisted laparoscopic devascularization and splenectomy proved an effective procedure for treating esophagogastric varices in patients with portal hypertension.

Solitary splenic metastasis of pulmonary carcinoid: A rare case report and literature review.

We herein report a rare case of solitary splenic metastasis of a pulmonary carcinoid, for which hand-assisted laparoscopic splenectomy was performed. A 73-year-old man was admitted to the Inoue Hospital (Fukuyama, Japan) in March 2015 with an abnormal shadow of the spleen. The patient had a history of right upper lobectomy with lymph node dissection for a pulmonary typical carcinoid (pT1N0M0 stage IA) 7 years earlier. Plain abdominal computed tomography (CT) revealed a low-density area in the spleen. Enhanced abdominal CT revealed a mass in the spleen measuring 3×3 cm. Blood tests and tumor marker analysis revealed no abnormalities. Abdominal magnetic resonance imaging revealed a mass that was low-intensity on T1- and high-intensity on T2-weighted images, and positron emission tomography revealed abnormal fluorodeoxyglucose accumulation in the mass. Hand-assisted laparoscopic splenectomy was performed for diagnosis and treatment. The resected specimen included a reddish-brown mass. On immunohistochemistry, the mass was positive for chromogranin A, synaptophysin and CD56, which was similar to the resected pulmonary carcinoid tumor; thus, splenic metastasis of pulmonary carcinoid was diagnosed. The postoperative course was uneventful and the patient is currently under observation and remains recurrence-free, with no adjuvant chemotherapy.

Impact of obesity on hand-assisted laparoscopic splenectomy combined with esophagogastric devascu-larization

Objective To study the impact of obesity on the perioperative outcomes of hand-assisted laparoscopic splenectomy combined with esophagogastric devascularization (LSED). Methods The clinical data of patients who underwent hand-assisted laparoscopic splenectomy combined with esophagogastric devascularization between Jan. 2013 and Nov. 2015 were retrospectively analyzed. The patients were classified as obese group A (BMI≥28 kg/m2) or non-obese group B (BMI 20 cm) and A2 splenomegaly (diameter ≤20 cm). The conversion rates, operative complications, mortality, length of stay, operative time, and blood loss were analyzed and compared. Results One hundred and sixty patients who underwent hand-assisted LSED were included into this study. 54 patients were in group A and 106 in group B. A significantly longer operative time was found in group A (291 min vs. 261 min, P 0.05). The mean operative time was significantly longer in group A1 (336 min vs. 270 min; P 0.05). Conclusions Hand-assisted laparoscopic splenectomy combined with esophagogastric devascularization for obese patients was safe and feasible. However, for patients with massive splenomegaly, LSED should be performed with caution. Key words: Obesity; Hand-assisted laparoscopic splenectomy; Devascularization; Massive splenomegaly; Perioperative period

Clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization

Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 64 patients who underwent laparoscopic splenectomy combined with pericardial devascularization at the Second Affiliated Hospital of Kunming Medical University from April 2012 to June 2015 were collected. Observed indexes included (1) treatment outcomes, including surgical procedures, operation time, volume of intraoperative blood loss, time of postoperative enteral recovery, time of postoperative drainage tube removal, duration of postoperative hospital stay, occurrence of complications, (2)follow-up situation. The follow-up using reexaminations of blood routine, liver function, coagulation function, gastroscopy and color Doppler ultrasonography of portal vein was performed regularly at postoperative month 1, 2, 3, 6, 12, 24 until reemergence of gastrointestinal hemorrhage. The final deadline was death of patients and performance of liver transplantation. Measurement data with normal distribution were presented as ±s. Results (1) Treatment outcomes: of 64 patients, 62 underwent total laparoscopic splenectomy combined with pericardial devascularization successfully. One patient was transffered to hand-assisted laparoscopic splenectomy combined with pericardial devascularization due to uncontrollable hemorrhage. One patient received laparoscopic cholecystectomy firstly with volume of blood loss of about 1 500 mL and terminated surgery after infusion of suspension red blood cells of 6 U and plasma of 900 mL, and underwent laparoscopic splenectomy combined with pericardial devascularization again next week. No postoperative hemorrhage, pancreatic leakage or death occurred during the perioperative period. The operation time, volume of intraoperative blood loss, time of postoperative enteral recovery, time of postoperative drainage tube removal and duration of postoperative hospital stay were (146±33)minutes, (214±31)mL, (24±4)hours, 7 days and (14±6)days, respectively. Nine patients had postoperative pleural effusion and recovered after thoracic drainage and thoracentesis. (2) Follow-up situation: All the 64 patients were followed up for an average time of 19.7 months (range, 3.0-23.0 months). Reexamination of gastroscopy showed improvement of varicosed veins of lower esophagus and fundus of stomach. During the postoperative 3 months, 4 patients had portal vein thrombosis with level of PLT>700×109/L. For patients with D-Dimer>5, low molecular weight heparin of 0.4 U was injected subcutaneously until D-Dimer<2. Three patients were loss to follow-up at postoperative month 6 without upper gastrointestinal hemorrhage, hepatic encephalopathy or liver failure. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is safe and effective for portal hypertension, and rigorous perioperative management offers guarantee for surgical safety. Key words: Portal hypertension; Splenectomy; Pericardia devascularization; Laparoscopy

Hand-assisted laparoscopic splenectomy for patients with massive splenomegaly due to portal hypertension

Hand-assisted laparoscopic splenectomy for patients with massive splenomegaly due to portal hypertension

In this issue – June 2015

In this issue – June 2015