title: Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage.
abstract: BACKGROUND
  Intraoperative blood salvage can reduce or avoid perioperative allogeneic blood transfusion. Salvaging the blood in the portal hypertension-induced enlarged spleen becomes an issue of concern during devascularization surgery because an enlarged spleen accommodates a large red cell pool. We report 20 cases of laparoscopic splenectomy and azygoportal disconnection and present the advantages of the use of intraoperative splenic blood salvage during the procedure.
  
  
  METHODS
  A total of 20 cirrhotic patients with esophagogastric variceal bleeding refractory to treatment with β-blockers and endoscopic therapy were studied. Laparoscopic splenectomy with azygoportal disconnection was performed. During the procedure, an intraoperative autologous blood salvage device recovered the splenic blood. The perioperative data were recorded from various viewpoints.
  
  
  RESULTS
  The operative time was 3.1 ± 0.3 h and the blood loss was 70.5 ± 32.5 ml. The weight of the excised and morcellated spleen was 826.0 ± 155.1 g. The volume of autotransfused blood was 541.0 ± 150.4 ml. No patient received a perioperative allogeneic blood transfusion. There were no significant complications either intraoperatively or postoperatively. The hemoglobin value increased from 9.3 ± 0.8 to 11.5 ± 1.1 g/dl at postoperative day 1 (p < 0.01). During a postoperative follow-up period of 18.0 ± 9.0 months for 18 patients, neither esophageal variceal bleeding nor encephalopathy recurred.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy with azygoportal disconnection is a feasible, effective, and safe surgical method for the treatment of bleeding portal hypertension. Intraoperative splenic blood salvage can avoid the risk associated with allogeneic transfusion during the procedure, with an advantage of significantly increased postoperative hemoglobin levels.
authors.affiliation: Department of General Surgery, Zhejiang Provincial People's Hospital, 158 Shangtang Rd, Hangzhou 310014, China. wydong2003@hotmail.com
authors.forename: Yuedong
authors.initials: Y
authors.lastname: Wang
authors.forename: Yun
authors.initials: Y
authors.lastname: Ji
authors.forename: Yangwen
authors.initials: Y
authors.lastname: Zhu
authors.forename: Zhijie
authors.initials: Z
authors.lastname: Xie
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Zhan
mesh_terms: D000328:Adult; D001401:Azygos Vein / Q000601:surgery; D016063:Blood Loss, Surgical; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005240:Feasibility Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D010535:Laparoscopy / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000379:methods*; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000150:complications