Laparoscopic Pericardial Devascularization For The Treatment Of Portal Hypertension In Cirrhotic Patients

Objective:To research the feasibility,effectiveness and safety of laparoscopic splenectomy combined with pericardial devascularization with open procedures for the treatment of portal hypertension in cirrhotic patients.Summary the surgical techniques and clinical value of the laparoscopic operation.Methods:In this retrospective study from June 2006 to June 2008,26 cases underwent splenectomy and paraesophagogastric devascularization by dissecting secondary branches of splenic pedicle by one treatment team,in these patients,16 cases undergoing laparoscopic surgery and 10 cases undergoing open surgery served as controls.Clinical data including operative time,intraoperative blood loss,post-operative complications,amount of post-operative platelet,post-operative gastrointestinal decompression stop time,post-operative pain relief time and hospitalization were compared between the two groups.Results:LS combined with pericardial devascularization was successfully performed on these 12 cases.10 patients were smoothly performed with biological clamps by dissecting secondary branches of splenic pedicle,2 cases were convened to traditional LS with Endo-GIA.4 cases were converted to open surgery due to perisplenic extensive dence adhesions(1 cases),left diaphragm vein injury(l case),splenic lobe vein injury(2 cases).The operative time of laparoscopic group and the open group was respectively(315±77)min and(291±31)min,there is no significant difference(p=0.384).The mean intro-operative blood loss was(409±216)ml and (980±402)ml respectively,there is significant difference(p<0.01).The post-operative stay was(9.8±3.3)d and(16.6±8.1)d,there is significant difference(p<0.01).There was no operative mortality in neither groups and there is no significant differences in post-operative complication rate between the two groups(16.7%vs30.0%,P=0.525).All patients were followed up for 6 - 30 months,there was only one patient recurent bleeding 20 months after operation in the laparoscopic group,rebleeding rate was 8.3 %,there is no significant difference between the two groups(P=0.329).Conclusion:With experienced laparoscopic skills and full pre-operative preparation, Laparoscopic splenectomy combine pericardial devascularization is feasible,effective and safety,also has the advantage of less intra-operative blood loss,shorter hospital -lization than open sufgery,easy to accept for the patients.