title: A meta-analysis study of laparoscopic versus open splenectomy with or without esophagogastric devascularization in the management of liver cirrhosis and portal hypertension.
abstract: BACKGROUND
  The aim of this meta-analysis was to determine whether laparoscopic splenectomy (LS) and LS with esophagogastric devascularization (LSED) were the minimally invasive alternative for portal hypertension.
  
  
  METHODS
  A meta-analysis of comparative clinical trials was performed to assess our questions noted above. The databases PubMed, ScienceDirect, and Springerlink were searched.
  
  
  RESULTS
  In total, 725 patients with liver cirrhosis and/or portal hypertension from eight published comparative trials were included. The operation time in the laparoscopic group was more than that in the open group [weighted mean difference (WMD) 35.24 (16.74, 53.74); P<.001]. However, there were less intraoperative blood loss [WMD -194.84 (-321.34, -68.34); P=.003] and a shorter postoperative hospital stay [WMD -4.33 (-5.30, -3.36); P<.001] in the laparoscopic group. The incidence of complications was similar in the two groups. In the subgroup studies about LS versus open splenectomy, no significant differences were found in operation time, intraoperative blood loss, and complication rates. The postoperative hospital stay in the LS group was apparently decreased [WMD -4.07 (-4.93, -3.21); P<.001]. Although the operation time of LSED was longer [WMD 43.23 (17.13, 69.32); P=.001], LSED was associated with less intraoperative blood loss [WMD -189.26 (-295.71, -82.81); P<.001] and a shorter postoperative hospital stay [WMD -5.41 (-7.84, -2.98); P<.001]. Meta-analysis did not favor either LSED or open splenectomy with esophagogastric devascularization in term of complication rates.
  
  
  CONCLUSIONS
  The results of this meta-analysis were in favor of LS and LSED for being a safe, minimally invasion alternative for patients with liver cirrhosis and portal hypertension.
authors: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi, China .
authors: Xin
authors: X
authors: Zheng
authors: Changwei
authors: C
authors: Dou
authors: Yingmin
authors: Y
authors: Yao
authors: Qingguang
authors: Q
authors: Liu
mesh_terms: D016063:Blood Loss, Surgical; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery*; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013270:Stomach / Q000601:surgery*