Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 634-642
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.634
In situ subtotal spleen resection combined with selective pericardial devascularization for the treatment of portal hypertension
Hai-Lin Li, Shang-Lei Ning, Yan-Jing Gao, Tao Zhou, Yu-Xin Chen
Hai-Lin Li, Shang-Lei Ning, Yu-Xin Chen, Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Yan-Jing Gao, Tao Zhou, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Chen YX designed and performed the operation; Li HL and Ning SL contributed to acquisition, interpretation and analysis of clinical data and wrote the manuscript; Gao YJ and Zhou T designed the research and contributed to critical revision of the manuscript for important intellectual content; and all authors approved the final version of the manuscript.
Supported by Chinese Postdoctoral Science Foundation, No. 2022M711911.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Qilu Hospital of Shandong University.
Informed consent statement: The surgical protocol and postoperative follow-up were approved by the patients and their families. All procedures were conducted in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: There is no conflict of interest associated with the author or coauthors contributing to this manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address: yxchen@sdu.edu.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Xin Chen, MD, Professor, Surgeon, Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital of Shandong University, No. 107 Wenhua west Road, Jinan 250012, Shandong Province, China. yxchen@sdu.edu.cn
Received: December 19, 2022
Peer-review started: December 19, 2022
First decision: January 9, 2023
Revised: January 24, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 27, 2023
Processing time: 124 Days and 20.6 Hours
Abstract
BACKGROUND

Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension (PHT). In recent years, increasing attention has been given to spleen preservation operations. The mode and long-term effects of subtotal splenectomy and selective pericardial devascularization for PHT remain controversial.

AIM

To investigate the clinical efficacy and safety of subtotal splenectomy combined with selective pericardial devascularization for the treatment of PHT.

METHODS

This was a retrospective study of 15 patients with PHT who underwent subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization in the Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University from February 2011 to April 2022. Fifteen propensity score-matched patients with PHT who underwent total splenectomy at the same time served as the control group. The patients were followed for up to 11 years after surgery. We compared the postoperative platelet levels, perioperative splenic vein thrombosis, and serum immunoglobulin levels between the two groups. Abdominal enhanced computed tomography was used to evaluate the blood supply and function of the residual spleen. The operation time, intraoperative blood loss, evacuation time, and hospital stay were compared between the two groups.

RESULTS

The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower than that in the total splenectomy group (P < 0.05), and the postoperative portal system thrombosis rate in the subtotal splenectomy group was also much lower than that in the total splenectomy group. The levels of serum immunoglobulins (IgG, IgA, and IgM) showed no significant differences after surgery compared with before surgery in the subtotal splenectomy group (P > 0.05), but serum immunoglobulin IgG and IgM levels decreased dramatically after total splenectomy (P < 0.05). The operation time in the subtotal splenectomy group was longer than that in the total splenectomy group (P < 0.05), but there were no significant differences in the amount of intraoperative blood loss, evacuation time, or hospital stay between the two groups.

CONCLUSION

Subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT, not only correcting hypersplenism but also preserving splenic function, especially immunological function.

Keywords: Subtotal splenectomy; Portal hypertension; Surgical treatment; Splenic function; Selective pericardial devascularization

Core Tip: Partial spleen resection is beneficial for benign lesions in normal spleens. However, many issues regarding subtotal spleen resection for portal hypertension remain elusive. We performed subtotal spleen resection in situ without preserving the splenic artery and vein for portal hypertension and evaluated perioperative complications and clinical effects retrospectively. Follow-up results showed that subtotal splenectomy is a safe and effective surgical treatment for patients with portal hypertension, not only correcting hypersplenism but also preserving splenic function.