Comparative Analysis Of Laparoscopic Splenectomy With Periesophagogastric Devascularization And Open Surgery

Objective:To investigate the clinical effect between laparoscopic splenectomy with periesophagogastric devascularization (LSD) and open surgery(OSD);Methods:Between April2012to April2013,37patients with cirrhotic portal hypertension(PHT) underwent splenectomy with periesophagogastric devascularization surgery in Zhejiang Province People’s Hospital. We compared the gender, age, etiology of cirrhosis, liver function, size of spleen, severity of esophageal varices. All the patients were divided into open surgery group and laparoscopic group randomly, including18cases in LSD and19cases in OSD. Operative time, volume of blood loss, volume of blood transfusion, complication, postoperative hospital stay were analyzedResults:18patients underwent LSD, including15hepatitis B viral cirrhosis,2alcoholic cirrhosis,l schistosomiasis cirrhosis; According to Child-Pugh grading,12patients were degree A with6cases of degree B; All patients received endoscopy or gastroenterography. Four patients had moderate varices. Two patients were varices of moderate to severe degree. Twelve cases were severe degree. Ninteen patients underwent OSD, including14cases of hepatitis B viral cirrhosis,3cases of alcoholic cirrhosis and2cases of schistosomiasis cirrhosis. According to Child-Pugh grading,13 patients were degree A and6were degree B. All the patients underwent endoscopy or gastroenterography. Four patients were varices of moderate degree,3of moderate to severe degree and12of severe degree. Only one case in LSD was conversed to open surgery due to uncontrolled bleeding. The operative time in LSD and OSD were315±77min and291±31min (P=0.38). Blood loss during operation were276.7±212.0ml and502.6±469.2ml in LSD and OSD group (P=0.047). Blood transfusion in operation were26.7±103.3ml and432.8±776.7ml in LSD and OSD respectively(P=0.020).In LSD and OSD, red blood cell transfusion after operation were73.3±410.5ml and215.4±827.9ml(P=0.068), with plasma transfusion postoperation of404±484.6ml and1111.6±1315.7ml respectively (P=0.029).In LSD, there were2cases of ascites and/or pleural effusion,1case of portal veinic thrombosis,1case of pancreatic leakage,1case of encephalopathy who recovered well after medical treatment. Total incidence of complication was27.8%. While in OSD, there were5cases of ascites and/or pleural effusion,4cases of pulmonary infection,2cases of wound infection,8cases of portal veinic thrombosis,2case of pancreatic leakage,1case of encephalopathy who died soon,1case of upper gastrointestinal bleeding who underwent reopertion,l case of splenic fever. Total incidence of complication was84.2%. There was no significant difference in PT and PLT level between two groups. No difference of ALT was found except on day7after operation.CRP was found significantly lower in LSD than in OSD,while IgM was a little higher. Gastrointestinal decompression tube were removed on day3.9±1.0d in LSD and on4.3±2.4d in OSD (P=0.27). Average flatus time was4.7±1.9din LSD and6.9±2.6d in OSD (P=0.041). Average feeding time was5.9±2.0d in LSD and9.6±3.6d in OSD (P=0.00066). Average postoperative hospital stay was11.7±2.0d in LS and18.6±9.2d in OS (P=0.015).Conclusion:Laparoscopic splenectomy with periesophagogastric devascularization was feasible and practical, which was less invasive compared to open approach.The technique of non-separated control of splenic artery and vein by using Endo-GIA is feasible,safe and effective.