Total Laparoscopic Versus Open Selective Pericardial Devascularization:a Retrospective Comparative Study

Objectives: To compare the efficacy of laparoscopic selective pericardial dev ascularization(LSPD)and open selective pericardial devascularization(OSPD) in the treatment of portal hypertension complicated with upper gastrointestin al bleeding,and evaluate the safety and practicability of LSPD.Methods: The clinical data of 105 patients who underwent selective pericard ial devascularization to treat portal hypertension complicated with upper gastr ointestinal bleeding from January 2011 to January 2016 was collected retrosp ectively.23 patients received LSPD and 82 patients received OSPD.Results: 105 patients were followed up ranging from 5 to 61 months,an av erage of 24 months.Surgical hemostasis was achieved in all patients.The opera tion time of LSPD group was longer than that of OSPD group(253.30±66.63vs197.47±47.16/min,p<0.05),but the average time of postoperative ambulati on,anal exhaust and pain relief in LSPD group were shorter than those in OSPD group(2.17±0.39vs2.67±0.57/d,1.43±0.59vs2.23±0.67/d,2.22±0.74vs3.29±0.79/d,p<0.05);There was no significant difference in intraoperative blood los s,intraoperative blood transfusion rate,postoperative platelet count,postopera tive hospital stay and postoperative portal vein thrombosis rate.The overall perioperative complication rate in the LSPD group was 21.74%,including 2 patients with portal vein thrombosis,1 patient with short-term rebleeding,3 patients with pulmonary infection,2 patients with pleural effusion and 1 pati ent with abdominal infection;4 patients had long-term rebleeding.The overa ll perioperative complication rate in the OSPD group was 32.93%,including 8 patients with portal vein thrombosis,7 patients with short-term rebleeding,9 patients with pulmonary infection,6 patients with pleural effusion and 3 p atients with abdominal infection,3 patients with incision infection,2 patients with sepsis,1 patient with ischemic necrosis of the posterior wall of stomach,1 patient with hepatic encephalopathy;10 patients had long-term rebleedi ng.There was no significant difference in the overall perioperative complicat ion rate,short-term rebleeding rate,long-term rebleeding rate,long-term reble eding time and overall survival rate between the two groups.Conclusions: LSPD is safe and feasible in the treatment of portal hypertensi on complicated with upper gastrointestinal bleeding,and it has the characteri stics of less intraoperative blood loss,rapid postoperative recovery and obvio us efficacy.With the advantages of laparoscopic surgery and reasonable perio perative management,the laparoscopic approach to splenectomy for massive sple nomegaly is feasible and safe.It is helpful to reduce postoperative bleeding t o severed blood vessels in the lower part of the esophagus up to 6~8cm an d receive postoperative anticoagulation therapy early.