Laparoscopic Splenectomy for Hypersplenism Secondary to Liver Cirrhosis and Portal Hypertension

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2014 Jun 11

PMID 24914339

Citations 19

Authors

Xiao-Li Zhan

Yun Ji

Yue-Dong Wang

Affiliations

Soon will be listed here.

Abstract

Since the first laparoscopic splenectomy (LS) was reported in 1991, LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign conditions. Compared with open splenectomy, fewer postsurgical complications and better postoperative recovery have been observed, but LS is contraindicated for hypersplenism secondary to liver cirrhosis in many institutions owing to technical difficulties associated with splenomegaly, well-developed collateral circulation, and increased risk of bleeding. With the improvements of laparoscopic technique, the concept is changing. This article aims to give an overview of the latest development in laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension. Despite a lack of randomized controlled trial, the publications obtained have shown that with meticulous surgical techniques and advanced instruments, LS is a technically feasible, safe, and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension and contributes to decreased blood loss, shorter hospital stay, and less impairment of liver function. It is recommended that the dilated short gastric vessels and other enlarged collateral circulation surrounding the spleen be divided with the LigaSure vessel sealing equipment, and the splenic artery and vein be transected en bloc with the application of the endovascular stapler. To support the clinical evidence, further randomized controlled trials about this topic are necessary.

Citing Articles

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References

Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot J, Leandros E . Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008; 22(4):821-48. DOI: 10.1007/s00464-007-9735-5. View

Kakinoki K, Okano K, Suto H, Oshima M, Hagiike M, Usuki H . Hand-assisted laparoscopic splenectomy for thrombocytopenia in patients with cirrhosis. Surg Today. 2012; 43(8):883-8. DOI: 10.1007/s00595-012-0413-4. View

Wang K, Hu S, Zhang G, Chen B, Zhang H . Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy. Chin Med J (Engl). 2007; 120(1):41-5. View

Shimada M, Hashizume M, Shirabe K, Takenaka K, Sugimachi K . A new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism. Performing a hepatectomy after a laparoscopic splenectomy. Surg Endosc. 2000; 14(2):127-30. DOI: 10.1007/s004649900082. View

Owera A, Hamade A, Bani Hani O, Ammori B . Laparoscopic versus open splenectomy for massive splenomegaly: a comparative study. J Laparoendosc Adv Surg Tech A. 2006; 16(3):241-6. DOI: 10.1089/lap.2006.16.241. View

Targarona E, Espert J, Balague C, Piulachs J, Artigas V, Trias M . Splenomegaly should not be considered a contraindication for laparoscopic splenectomy. Ann Surg. 1998; 228(1):35-9. PMC: 1191425. DOI: 10.1097/00000658-199807000-00006. View

Ikeda K, Saitoh S, Suzuki Y, Kobayashi M, Tsubota A, Koida I . Disease progression and hepatocellular carcinogenesis in patients with chronic viral hepatitis: a prospective observation of 2215 patients. J Hepatol. 1998; 28(6):930-8. DOI: 10.1016/s0168-8278(98)80339-5. View

Yan Q, Zhu J, Zhan X, Weng W, Wu W, Shen D . Primary versus secondary splenic pedicle dissection in laparoscopic splenectomy for splenic diseases. J Am Coll Surg. 2012; 216(2):266-71. DOI: 10.1016/j.jamcollsurg.2012.10.019. View

Weiss 3rd C, Kavic S, Adrales G, Park A . Laparoscopic splenectomy: what barriers remain?. Surg Innov. 2005; 12(1):23-9. DOI: 10.1177/155335060501200104. View

10.

Zhu J, Wang Y, Ye Z, Zhao T, Zhu Y, Xie Z . Laparoscopic versus open splenectomy for hypersplenism secondary to liver cirrhosis. Surg Laparosc Endosc Percutan Tech. 2009; 19(3):258-62. DOI: 10.1097/SLE.0b013e3181a6ec7c. View

11.

Hirooka M, Ishida K, Kisaka Y, Uehara T, Watanabe Y, Hiasa Y . Efficacy of splenectomy for hypersplenic patients with advanced hepatocellular carcinoma. Hepatol Res. 2008; 38(12):1172-7. DOI: 10.1111/j.1872-034X.2008.00389.x. View

12.

Anegawa G, Kawanaka H, Uehara H, Akahoshi T, Konishi K, Yoshida D . Effect of laparoscopic splenectomy on portal hypertensive gastropathy in cirrhotic patients with portal hypertension. J Gastroenterol Hepatol. 2009; 24(9):1554-8. DOI: 10.1111/j.1440-1746.2009.05906.x. View

13.

Bo W, He-Shui W, Guo-Bin W, Kai-Xiong T . Laparoscopy splenectomy for massive splenomegaly. J Invest Surg. 2013; 26(3):154-7. DOI: 10.3109/08941939.2012.691604. View

14.

Kercher K, Carbonell A, Heniford B, Matthews B, Cunningham D, Reindollar R . Laparoscopic splenectomy reverses thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension. J Gastrointest Surg. 2004; 8(1):120-6. DOI: 10.1016/j.gassur.2003.10.009. View

15.

Motomura T, Shirabe K, Furusyo N, Yoshizumi T, Ikegami T, Soejima Y . Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype. BMC Gastroenterol. 2012; 12:158. PMC: 3503804. DOI: 10.1186/1471-230X-12-158. View

16.

Zheng X, Liu Q, Yao Y . Laparoscopic splenectomy and esophagogastric devascularization is a safe, effective, minimally invasive alternative for the treatment of portal hypertension with refractory variceal bleeding. Surg Innov. 2012; 20(1):32-9. DOI: 10.1177/1553350612441863. View

17.

Hama T, Takifuji K, Uchiyama K, Tani M, Kawai M, Yamaue H . Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. J Hepatobiliary Pancreat Surg. 2008; 15(3):304-9. DOI: 10.1007/s00534-007-1232-7. View

18.

Wang Y, Ye H, Ye Z, Zhu Y, Xie Z, Zhu J . Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism. J Laparoendosc Adv Surg Tech A. 2008; 18(1):37-41. DOI: 10.1089/lap.2007.0028. View

19.

Casaccia M, Torelli P, Squarcia S, Sormani M, Savelli A, Troilo B . Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS). Surg Endosc. 2006; 20(8):1214-20. DOI: 10.1007/s00464-005-0527-5. View

20.

Wang X, Li Y, Zhou J, Wu Z, Peng B . Hand-assisted laparoscopic splenectomy is a better choice for patients with supramassive splenomegaly due to liver cirrhosis. J Laparoendosc Adv Surg Tech A. 2012; 22(10):962-7. DOI: 10.1089/lap.2012.0237. View