title: Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review.
abstract: OBJECTIVE
  Given the technical difficulty of laparoscopic splenectomy and azygoportal disconnection (LSD), data are limited that compare the laparoscopic to the open procedure. As the technique becomes more widespread, questions regarding its safety, feasibility, and reproducibility must be addressed. This review assesses the current status of LSD.
  
  
  METHODS
  We conducted our literature review with a search of the PubMed database. All published series of 5 or more laparoscopic splenectomy and azygoportal disconnection procedures were examined. The demographic, intraoperative, and postoperative data analyzed included number of ports, conversion rate, operative duration, estimated intraoperative blood loss, postoperative hospital stay, and complications.
  
  
  RESULTS
  Fifteen articles met the review criteria. Of 412 laparoscopic procedures, traditional laparoscopic splenectomy and azygoportal disconnection (TLSD) was used in 322 patients (78.2%), a modified laparoscopic procedure (MLSD) in 79 (19.2%), and a single-incision laparoscopic procedure (SLSD) in 11 (2.7%). Compared with the traditional and single-incision laparoscopic procedures, the MLSD procedure was associated with shorter operative duration and less blood loss. Furthermore, although the incidence of postoperative portal vein system thrombosis was higher in the laparoscopic than in the open splenectomy with azygoportal disconnection (OSD) procedure, the LSD procedure was associated with less pulmonary infection and pleural effusion and fewer incisional and overall complications than the open procedure. The rate of conversion to an open procedure was 5.4%.
  
  
  CONCLUSIONS
  LSD is feasible and safe for selected patients when performed by an expert laparoscopic surgeon. It has perioperative advantages over OSD, but studies with longer follow-up periods and larger samples of patients are needed.
authors.affiliation: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Jiang
authors.affiliation: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Dou-Sheng
authors.initials: DS
authors.lastname: Bai
authors.affiliation: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Qian
authors.affiliation: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Jin
mesh_terms: D001401:Azygos Vein / Q000601:surgery*; D016063:Blood Loss, Surgical; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D015203:Reproducibility of Results; D013156:Splenectomy / Q000379:methods*
keywords: Azygoportal disconnection; Hypertension; Laparoscopy; Portal; Splenectomy