title: Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion.
abstract: OBJECTIVE
  To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.
  
  
  METHODS
  We retrospectively evaluated outcomes in 79 patients admitted to the Clinical Medical College of Yangzhou University with cirrhosis, portal hypertensive bleeding and secondary hypersplenism who underwent MLSD without (n = 46) or with intraoperative cell salvage and autologous blood transfusion, including splenic blood and operative hemorrhage (n = 33), between February 2012 and January 2014. Their intraoperative and postoperative variables were compared. These variables mainly included: operation time; estimated intraoperative blood loss; volume of allogeneic blood transfused; visual analog scale for pain on the first postoperative day; time to first oral intake; initial passage of flatus and off-bed activity; perioperative hemoglobin (Hb) concentration; and red blood cell concentration.
  
  
  RESULTS
  There were no significant differences between the groups in terms of duration of surgery, estimated intraoperative blood loss and overall perioperative complication rate. In those receiving salvaged autologous blood, Hb concentration increased by an average of 11.2 ± 4.8 g/L (P < 0.05) from preoperative levels by the first postoperative day, but it had fallen by 9.8 ± 6.45 g/L (P < 0.05) in the group in which cell salvage was not used. Preoperative Hb was similar in the two groups (P > 0.05), but Hb on the first postoperative day was significantly higher in the autologous blood transfusion group (118.5 ± 15.8 g/L vs 102.7 ± 15.6 g/L, P < 0.05). The autologous blood transfusion group experienced significantly fewer postoperative days of temperature > 38.0°C (P < 0.05).
  
  
  CONCLUSIONS
  Intraoperative cell salvage during MLSD is feasible and safe and may become the gold standard for liver cirrhosis with portal hypertensive bleeding and hypersplenism.
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Jiang
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Dou-Sheng
authors.initials: DS
authors.lastname: Bai
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Qian
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Jin
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yao
authors.affiliation: Guo-Qing Jiang, Dou-Sheng Bai, Ping Chen, Jian-Jun Qian, Sheng-Jie Jin, Jie Yao, Xiao-Dong Wang, Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D002681:China; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006785:Hospitals, University; D006801:Humans; D006971:Hypersplenism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: Azygoportal disconnection; Cell salvage; Laparoscopy; Portal hypertension; Splenectomy