Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.634
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
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.
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.
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.
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.
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.
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.
Subtotal splenectomy is suitable for specific PHT patients but the mode and long-term effects requires further study.