Li HL, Ning SL, Gao YJ, Zhou T, Chen YX. In situ subtotal spleen resection combined with selective pericardial devascularization for the treatment of portal hypertension. World J Gastrointest Surg 2023; 15(4): 634-642 [PMID: 37206069 DOI: 10.4240/wjgs.v15.i4.634]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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.
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
ARTICLE HIGHLIGHTS
Research background
Liver cirrhosis caused by chronic hepatitis B virus infection is the main pathogenic factor of portal hypertension (PHT) in China. For patients with serious esophagogastric variceal hemorrhage that cannot be controlled by endoscopic treatment, total splenectomy and selective pericardial devascularization are the main surgical methods for the treatment of PHT in China.
Research motivation
As we know, the sharp increase of platelet level and portal system thrombosis after total splenectomy is a serious complication affecting the surgical outcome and can even lead to death. More and more attention has been paid to spleen preservation operations recently. However, the long-term effects of subtotal splenectomy for PHT remain controversial.
Research objectives
The objective of the study was to explore the clinical efficacy and safety of subtotal splenectomy in situ combined with selective pericardial devascularization for the treatment of PHT.
Research methods
The study summarized the clinical data of PHT patients who received subtotal spleen resection and selective pericardial devascularization. We compared the postoperative platelet level, perioperative spleen vein thrombosis, and serum immunoglobulin level with the control group. Abdominal enhanced computed tomography was used to evaluate the blood supply of the residual spleen. The operation time, intraoperative blood loss and other parameters were also evaluated statistically.
Research results
The follow-up results showed that the surgical approach was safe and effective. The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower and the postoperative portal system thrombosis rate was also much lower than that in the total splenectomy group. The levels of serum immunoglobulins (IgG, IgA, and IgM) showed no significant difference after operation in the subtotal splenectomy group.
Research conclusions
In situ subtotal splenectomy not preserving the splenic artery and vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT, not only correcting hypersplenism but also preserving the immunological function of spleen.
Research perspectives
Subtotal splenectomy is suitable for specific PHT patients but the mode and long-term effects requires further study.
