Laparoscopic Versus Open Splenectomy For Portal Hypertension Due To Liver Cirrhosis

Background The incidence of portal hypertension(PHT)with post-hepatitis liver cirrhosis is higher in China than anywhere in the world.Portal hypertension is that the most severe among the numerous complications of cirrhosis.There are two mechanisms through which cirrhosis can develop in pathologically raised portal venous pressures.Portal hypertension is described as a pathologic increase in portal venous system pressures.as the direct measurement of portal venous pressure is invasive and impractical,the measurement of the hepatic venous pressure gradient(HVPG)is now chosen for the diagnosis of portal hypertension.Hepatic venous pressure gradient refers to the pressure difference between the intra-abdominal inferior vena cava and the portal veins and normally ranges between1-5mm Hg.HVPG more than 5mm Hg is diagnostic of portal hypertension.Liver cirrhosis is stated as the histologic occurrence of renewal nodules encompassed with fibrous strips secondary to various etiologies.As a sequela of End Stage Liver Disease,liver cirrhosis can progress from a large number of etiologies that inflict frequently injuries to the liver cells.Alcohol-related and viral attacks are the most common causes worldwideObjective The objective was to compare the long-term and short-term safety and efficacy of laparoscopic splenectomy(LS)VS open splenectomy(OS)as the treatment of portal hypertension caused by liver cirrhosisDesign,place,and duration of study It is a retrospective study conducted at Department of hepatobiliary and pancreatic Surgery of first Hospital of Jilin University,from January 1,2015,to December 30,2016Patients and Methods Thirty-six patients with portal hypertension and liver cirrhosis undergo laparoscopic splenectomy LS an open splenectomy OS.We examined patient's electronic medical records regarding the liver functional reserve and the causes of liver cirrhosis.We collected preoperative laboratory and clinical data,operative variables and postoperative short-and long-term data and results prospectively.were analyzed retrospectively collected data of perioperative,and postoperative complications variables.All patients admitted in this study underwent a detailed demographic,clinical,and biochemical appraisal.The hematological response and liver function were evaluated before surgery testing peripheral blood count(hemoglobin,leukocytes,and platelets)and alanine aminotransferase(ALT),total bilirubin,and albumin assays.At the time of preoperative assessment for splenectomy,all of the patients underwent a computed tomography(CT)and color Doppler ultrasonography(US)scan to measure the diameter of the spleen and to check the presence of any splenic and portal vein system thrombosis(PSVT).After the operation seven days,all of the patients received careful screening for thrombosis.The patients who presented evidence of splenic or portal vein thrombosis by ultrasonography(US)underwent CT scan to confirm the degree of thrombosis.ResultsAll of the 36 patients,16 patients(44.4%)were operated on using the laparoscopic procedure.Of these,9(56.3%)were female and 7(43.7%)were male.Age ranged between31 and 69 years.Mean age was(50.5)years.Of the 20 patients(55.5%)undergoing OS,11(55.0%)were female and 9(45.0%)were male.Mean age was(46.7)years and ranged between 16 and 66 years.None of the patients in the LS group needed conversion to open surgery.The operation time was longer in the laparoscopic group with a p-value of(<0.001).The patients in the LS group their drainage tube removing time was significantly earlier than the patients in the OS group(p = 0.003)and also had shorter postoperative hospital stay(p = 0.648).There were no Intra-operative deaths,and the rates of PVTS incidences was higher in the LS group with a p value of 0.374 other complications were comparable in the two groups.Conclusion Development of portal hypertension is a common and generally life-threatening occurrence in patients with Liver cirrhosis.As a minimally invasive surgery,laparoscopic splenectomy has advantages over the open procedure in forms of shorter postoperative hospital stay,lesser blood loss,fewer complications associated with the operation,drainage tube removing and earlier resumption of oral intake.Although the learning curve is not defined,we consider that laparoscopic splenectomy for portal hypertension is a safeand feasible intervention in an effort to improve the treatment options and survival of patients.