2016 Volume 22 Issue 2 Pages 133-138
Progress in laparoscopic surgery, such as development of various devices and standardization of the procedure, increased the number of patients receiving laparoscopic splenectomy despite that advanced skills are required for operation in patients with massive splenomegaly due to portal hypertension. Portal Hypertension may provoke hypersplenisms leading to occurrence of thrombocytopenia. Also, the port-systemic shunts as esophageal and gastric varices are in general present in these patients. Thus, laparoscopic surgery has been adopted infrequently as a procedure for splenectomy in patients with portal hypertension. In our institute, however, we applied the hand-assisted laparoscopic surgery (HALS) for the procedure for splenectomy, in which the splenic hilum was resected at once by a linear stapler, in patients with massive splenomegaly due to portal hypertension. In the present paper, the validity and usefulness of such procedure were retrospectively evaluated in 21 patients. Massive splenomegaly was defined as resection of splenic tissues of more than 500 ml of volume which was calculated on CT imaging, and 8 patients receiving massive splenectomy (MS-group), while the remaining 13 patients were subjected as the control (C-group). Regarding preoperative patient's characteristics, the Child-Pugh scores, Body mass index (BMI) and baseline splenic volume were higher in patients in MS-group than in those in C-group (p=0.0015, p=0.0009 and p<0.00001, respectively), while operation times were longer and blood loss during the operation was more in volume in patients in MS-group than in those in C-group (p=0.0630 and p=0.0178, respectively). It is concluded that laparoscopic splenectomy using the HALS procedure including splenic hilum resection is useful as a therapeutic procedure for patients with splenomegaly due to portal hypertension, while the significance in especially patients with massive splenomegaly is required to be further evaluated, since baseline liver function is deteriorated in most of these patients and may provoke massive bleeding during the operation.
