Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy.
BACKGROUND
It is well known that conventional splenectomy, which requires careful handling and ligation of tissue of the splenic hilum, can easily cause complications such as splenic fever and pancreatic fistula. Here, we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy.


METHODS
We retrospectively compared and analyzed the complications, postoperative hospital stay, operative time, and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007. The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle. In addition, we analyzed the relationship between size of the spleen and occurrence of complications.


RESULTS
The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively). In addition, there was no significant difference in operative time and volume of blood loss between two groups. The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications.


CONCLUSIONS
These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula, and shorten the postoperative hospital stay, especially in the patients with a large spleen. So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy.
Liu
Ying-bin
YB
Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
Kong
Ying
Y
Wang
Xu-an
XA
Wang
Jian-wei
JW
Li
Jiang-tao
JT
Wang
Yong
Y
Chen
Yan
Y
Chen
De-qing
DQ
Weng
Wei-hong
WH
Zhang
Zhi-ping
ZP
Wu
Xiang-song
XS
Fei
Xiao-zhou
XZ
Quan
Zhi-wei
ZW
Li
Song-gang
SG
Li
Ji-yu
JY
Cao
Li-ping
LP
Peng
Shu-you
SY
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply* / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult