Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism.
OBJECTIVE
The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension.


METHODS
From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or =1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed.


RESULTS
There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively.


CONCLUSIONS
With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.
Kawanaka
Hirofumi
H
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. harrykw@v102.vaio.ne.jp
Akahoshi
Tomohiko
T
Kinjo
Nao
N
Konishi
Kozou
K
Yoshida
Daisuke
D
Anegawa
Go
G
Yamaguchi
Shohei
S
Uehara
Hideo
H
Hashimoto
Naotaka
N
Tsutsumi
Norifumi
N
Tomikawa
Morimasa
M
Koushi
Kenichi
K
Harada
Noboru
N
Ikeda
Yasuharu
Y
Korenaga
Daisuke
D
Takenaka
Kenji
K
Maehara
Yoshihiko
Y
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000473:pathology / Q000601:surgery*; D006975:Hypertension, Portal / Q000150:complications; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013156:Splenectomy / Q000379:methods / Q000592:standards*