Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism.
BACKGROUND
Bleeding from esophageal varices is an important cause of morbidity and mortality in patients with portal hypertension. The ideal surgical procedure should control bleeding with as little impairment of liver function as possible and with low rates of encephalopathy. Recently, significant progress in laparoscopic technology has enabled laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach in a less invasive way. In this paper, we present preliminary results for 25 patients in whom laparoscopic splenectomy and azygoportal disconnection were performed.


METHODS
Laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach were performed in 25 patients with cirrhosis, bleeding portal hypertension, and secondary hypersplenism between January 2000 and October 2006. Among them, 5 patients underwent a laparoscopic modified Sugiura procedure, the lower esophagus was transected, and then reanastomosed with a circular stapler.


RESULTS
Laparoscopic splenectomy and azygoportal disconnection were completed in all patients, except in 1 conversion, without significant morbidity. The operation time ranged from 4.0 to 5.5 hours and the blood loss was 100-400 mL. The postoperative hospital stay was 6-15 days. During a postoperative follow-up period of 3 months to 5 years in 22 patients, neither esophagus variceal bleeding nor encephalopathy has recurred.


CONCLUSIONS
Laparoscopic splenectomy and azygoportal disconnection are feasible, effective, and safe surgical procedures, and have all the benefits of minimally invasive surgery for patients with bleeding portal hypertension and hypersplenism. Laparoscopic splenectomy and azygoportal disconnection offer a new operative method for treatment of bleeding portal hypertension with hypersplenism.
Wang
Yue D
YD
Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China. wydong2003@hotmail.com
Ye
Huan
H
Ye
Zai Y
ZY
Zhu
Yang W
YW
Xie
Zhi J
ZJ
Zhu
Jin H
JH
Liu
Jin M
JM
Zhao
Ting
T
D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000601:surgery*; D016063:Blood Loss, Surgical; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006971:Hypersplenism / Q000601:surgery*; D006975:Hypertension, Portal / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013270:Stomach / Q000098:blood supply