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Technical standardization of laparoscopic splenectomy harmonized with hand‐assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism
Author(s) -
Kawanaka Hirofumi,
Akahoshi Tomohiko,
Kinjo Nao,
Konishi Kozou,
Yoshida Daisuke,
Anegawa Go,
Yamaguchi Shohei,
Uehara Hideo,
Hashimoto Naotaka,
Tsutsumi Norifumi,
Tomikawa Morimasa,
Koushi Kenichi,
Harada Noboru,
Ikeda Yasuharu,
Korenaga Daisuke,
Takenaka Kenji,
Maehara Yoshihiko
Publication year - 2009
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-009-0149-8
Subject(s) - medicine , cirrhosis , portal hypertension , splenectomy , blood loss , laparoscopic surgery , laparoscopy , surgery , spleen , general surgery
Background/purpose The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension. Methods From 1993 to 2008, 265 cirrhotic patients underwent LS. Child‐Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand‐assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (≧1,000 mL), perisplenic collateral vessels, or Child‐Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed. Results There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients ( P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min ( P < 0.01) and from 506 to 171 g ( P < 0.01), respectively. Conclusions With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.