Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9146
Revised: March 16, 2014
Accepted: April 15, 2014
Published online: July 21, 2014
Processing time: 181 Days and 0.6 Hours
AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy or open splenectomy and azygoportal disconnection for portal hypertension.
METHODS: This study included 44 patients who underwent modified laparoscopic splenectomy and azygoportal disconnection (MLSD) and 71 who underwent open procedures for portal hypertension. Blood samples were collected before surgery and on days 1, 3, and 7 after surgery. Markers of liver and renal function, C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) were measured, and perioperative variables were compared between the two groups.
RESULTS: The modified laparoscopic group showed significantly better and faster recovery, better liver and renal function, and fewer complications than the open group. CRP, IL-6, and PCT concentrations on postoperative days 1, 3, and 7 were significantly lower in the modified laparoscopic group than in the open group.
CONCLUSION: MLSD was associated with lower inflammatory immune responses, less impairment of liver and renal function, and faster and better recovery.
Core tip: Minimal surgical trauma is an important goal to both surgeons and patients. A novel technique, in which massively enlarged spleens are removed from the abdominal cavity with an electromechanical morcellator through an existing 12-mm port, was first developed by our surgical team for laparoscopic splenectomy and azygoportal disconnection, and greatly reduces surgical trauma for cirrhotic patients with bleeding portal hypertension and secondary hypersplenism. This technique resulted in minimal postoperative pain and scarring, faster and better postoperative recovery, and lower inflammatory immune responses.