Orthotopic spelenectomy and selective pericardial devascularization for portal hypertension / 中华普通外科杂志

Objective To evaluate orthotopic splenectomy and pericardial devascularization for the treatment of portal hypertension.Methods The modified anterior approach splenectomy includes dissection of the peri-splenic vessels and ligments before division of short gastric vessels.During pericardial devascularization,the dessection panel was close to the esophagus and the stomach,leaving intact both the anterior and posterior vagus trunks.Results 63 patients underwent this modified operation.The free portal pressure decreased from (38 ±4) cmH2O to(28 ±4)cmH2O.The average blood loss was (530 ± 37)ml.There was no mortality,nor perioperative gastric paralysis and portal venous thrombosis.By 12-36 months follow-up,there was no pancreatic leakage,hepatic coma and recurrence of bleeding.Intrahepatic portal venous thromboses were detected in 4 cases at the sixth postoperative months.Conclusions This modified splenectomy plus selective pericardial devascularization carries less bleeding and is safe and effective for the treatment of portal hypertension.

Efficacy of splenectomy plus selective pericardial devascularization under en-doscope in treatment of advanced schistosomiasis patients with portal hyper-tension and hypersplenism / 中国血吸虫病防治杂志

Objective To evaluate the efficacy of splenectomy plus selective pericardial devascularization under endoscope in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism so as to explore the minimally in-vasive and safer surgical treatment. Methods A secure splenectomy was performed with laparoscope and its supporting devices, and at the same time,the ligation of the left gastric vein and the ligation of esophageal vein perforating vertically into the esopha-gus were also performed in 14 advanced schistosomiasis patients with portal hypertension and hypersplenism. Results Among the 14 patients,the splenic artery was separated and clipped before the treatment of splenic pedicle. One patient was of conversion to open laparotomy for the splenic vein rupture bleeding in the separation. There was no death. Conclusion The operation of sple-nectomy plus selective pericardial devascularization under endoscope is effective,truly minimally invasive,and safe in the treat-ment of advanced schistosomiasis patients with portal hypertension and hypersplenism.

Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique / 中国微创外科杂志

Objective To summarize the experience of laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique. Methods By using silk ligature and hamonic scapel or the LigaSure, 6 patients with portal hypertension and esophagogastric varices underwent laparoscopic massive splenectomy and selective pericardial devascularization. Results All the operations were completed successfully under laparoscope. The intraoperative blood loss was 80~200 ml (mean, 130 ml). None of the patients required blood transfusion or conversion to open procedure. The operation time was 150~210 min (mean, 190 min). There were no surgical complications. All the patients resumed to normal activities 5 days after operation. Follow-up observations for 3~10 months (mean, 8 months) revealed no recurrent variceal hemorrhage. Conclusions Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique is a feasible, effective, safe, little hemorrhagic, and minimally invasive procedure for portal hypertension with esophagogastric varices.