2013 Volume 33 Issue 1 Pages 61-66
Laparoscopic devascularization of the upper stomach and splenectomy (Lap-Dev+Sp), known as Hassab's operation, is technically difficult in patients with portal hypertension because of the possibility of hemorrhage and enlarged collateral vessels. Laparoscopic-or Hand-assisted laparoscopic Dev+Sp was undertaken in 21 patients as a salvage treatment for endoscopic-resistant esophagogastric varices between 2000 and 2011. LigaSure Atlas or EnSeal was used for devascularization of the vessels. An autosuture device was applied to dissect the splenic hilum and left gastric and enlarged short gastric vessels. Since January 2005, we have adopted a standardized laparoscopic surgery (LS) approach to include the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or=1,000mL), perisplenic collateral vessels, or a Child-Pugh score of 9 or more. Our results have revealed that the vessel sealing system we developed and HALS significantly reduced the intraoperative blood loss. Our findings therefore suggest that laparoscopic devascularization of the upper stomach and splenectomy is currently a more feasible and effective surgery in patients with portal hypertension.
