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Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism.
J Laparoendosc Adv Surg Tech A. 2008 Feb; 18(1):37-41.JL

Abstract

BACKGROUND

Bleeding from esophageal varices is an important cause of morbidity and mortality in patients with portal hypertension. The ideal surgical procedure should control bleeding with as little impairment of liver function as possible and with low rates of encephalopathy. Recently, significant progress in laparoscopic technology has enabled laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach in a less invasive way. In this paper, we present preliminary results for 25 patients in whom laparoscopic splenectomy and azygoportal disconnection were performed.

PATIENTS AND METHODS

Laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach were performed in 25 patients with cirrhosis, bleeding portal hypertension, and secondary hypersplenism between January 2000 and October 2006. Among them, 5 patients underwent a laparoscopic modified Sugiura procedure, the lower esophagus was transected, and then reanastomosed with a circular stapler.

RESULTS

Laparoscopic splenectomy and azygoportal disconnection were completed in all patients, except in 1 conversion, without significant morbidity. The operation time ranged from 4.0 to 5.5 hours and the blood loss was 100-400 mL. The postoperative hospital stay was 6-15 days. During a postoperative follow-up period of 3 months to 5 years in 22 patients, neither esophagus variceal bleeding nor encephalopathy has recurred.

CONCLUSIONS

Laparoscopic splenectomy and azygoportal disconnection are feasible, effective, and safe surgical procedures, and have all the benefits of minimally invasive surgery for patients with bleeding portal hypertension and hypersplenism. Laparoscopic splenectomy and azygoportal disconnection offer a new operative method for treatment of bleeding portal hypertension with hypersplenism.

Authors+Show Affiliations

Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China. wydong2003@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18266572

Citation

Wang, Yue D., et al. "Laparoscopic Splenectomy and Azygoportal Disconnection for Bleeding Varices With Hypersplenism." Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, vol. 18, no. 1, 2008, pp. 37-41.
Wang YD, Ye H, Ye ZY, et al. Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism. J Laparoendosc Adv Surg Tech A. 2008;18(1):37-41.
Wang, Y. D., Ye, H., Ye, Z. Y., Zhu, Y. W., Xie, Z. J., Zhu, J. H., Liu, J. M., & Zhao, T. (2008). Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 18(1), 37-41. https://doi.org/10.1089/lap.2007.0028
Wang YD, et al. Laparoscopic Splenectomy and Azygoportal Disconnection for Bleeding Varices With Hypersplenism. J Laparoendosc Adv Surg Tech A. 2008;18(1):37-41. PubMed PMID: 18266572.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism. AU - Wang,Yue D, AU - Ye,Huan, AU - Ye,Zai Y, AU - Zhu,Yang W, AU - Xie,Zhi J, AU - Zhu,Jin H, AU - Liu,Jin M, AU - Zhao,Ting, PY - 2008/2/13/pubmed PY - 2008/5/14/medline PY - 2008/2/13/entrez SP - 37 EP - 41 JF - Journal of laparoendoscopic & advanced surgical techniques. Part A JO - J Laparoendosc Adv Surg Tech A VL - 18 IS - 1 N2 - BACKGROUND: Bleeding from esophageal varices is an important cause of morbidity and mortality in patients with portal hypertension. The ideal surgical procedure should control bleeding with as little impairment of liver function as possible and with low rates of encephalopathy. Recently, significant progress in laparoscopic technology has enabled laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach in a less invasive way. In this paper, we present preliminary results for 25 patients in whom laparoscopic splenectomy and azygoportal disconnection were performed. PATIENTS AND METHODS: Laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach were performed in 25 patients with cirrhosis, bleeding portal hypertension, and secondary hypersplenism between January 2000 and October 2006. Among them, 5 patients underwent a laparoscopic modified Sugiura procedure, the lower esophagus was transected, and then reanastomosed with a circular stapler. RESULTS: Laparoscopic splenectomy and azygoportal disconnection were completed in all patients, except in 1 conversion, without significant morbidity. The operation time ranged from 4.0 to 5.5 hours and the blood loss was 100-400 mL. The postoperative hospital stay was 6-15 days. During a postoperative follow-up period of 3 months to 5 years in 22 patients, neither esophagus variceal bleeding nor encephalopathy has recurred. CONCLUSIONS: Laparoscopic splenectomy and azygoportal disconnection are feasible, effective, and safe surgical procedures, and have all the benefits of minimally invasive surgery for patients with bleeding portal hypertension and hypersplenism. Laparoscopic splenectomy and azygoportal disconnection offer a new operative method for treatment of bleeding portal hypertension with hypersplenism. SN - 1092-6429 UR - https://www.unboundmedicine.com/medline/citation/18266572/Laparoscopic_splenectomy_and_azygoportal_disconnection_for_bleeding_varices_with_hypersplenism_ L2 - https://www.liebertpub.com/doi/10.1089/lap.2007.0028?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -