title: Comparison of open, laparoscopic, and hand-assisted laparoscopic devascularization of the upper stomach and splenectomy for treatment of esophageal and gastric varices: a single-center experience.
abstract: BACKGROUND
  Laparoscopic devascularization of the upper stomach and splenectomy (Dev+Sp), is technically difficult in patients with portal hypertension because of enlarged collateral vessels and spleen. This report presents the efficacy and safety of hand-assisted laparoscopic (HALS) Dev+Sp.
  
  
  METHODS
  Ten patients underwent HALS Dev+Sp as a treatment for esophagogastric varices between 2005 and 2012 (HALS group). A vessel-sealing system was used for devascularization of vessels. An autosuture device was applied to dissect the splenic hilum and the left gastric and enlarged short gastric vessels. The operative and postoperative data were compared between patients who previously underwent laparoscopic Dev+Sp (LAP group, n = 9) and conventional Dev+Sp (OP group, n = 10) between 2001 and 2008.
  
  
  RESULTS
  The mean operative time was 328, 336, and 245 min (P < 0.05) and the mean blood loss was 1786, 981, and 250 mL (P < 0.05) in the OP, LAP, and HALS groups, respectively. Laparoscopic surgery was converted to HALS in one patient and to open surgery in three patients. There were no conversions in the HALS group. There was no significant difference in the cumulative recurrence rate and bleeding rate in the groups.
  
  
  CONCLUSIONS
  HALS Dev+Sp is a feasible and effective surgery in patients with portal hypertension.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center of Integration of Advanced Medicine, Life Science and Innovative Technology, Kyushu University, Fukuoka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Hideo
authors.initials: H
authors.lastname: Uehara
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome
keywords: Esophageal varices; gastric varices; laparoscopic surgery