Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection

doi:10.3748/wjg.v20.i27.9146

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Jul 21, 2014; 20(27): 9146-9153
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9146

Table 1 Baseline demographic and clinical characteristics of the modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection groups

Variable	MLSD (n = 44)	OSD (n = 71)	P value
Gender, M/F, n	27/17	41/30	0.701
Age, mean ± SD, yr	54.98 ± 10.41	52.46 ± 10.33	0.209
Etiology, n
HBV cirrhosis	23	46	0.183
HCV cirrhosis	3	5	0.963
Schistosome cirrhosis	6	9	0.882
Alcoholic cirrhosis	3	4	0.796
Autoimmunity liver cirrhosis	9	7	0.111
APACHE II score, mean ± SD	3.32 ± 2.27	3.49 ± 2.57	0.712
Child-Pugh classification, A/B, n	29/15	39/32	0.244
Longitudinal diameter of spleen, mean ± SD, mm	179.45 ± 27.88	185.44 ± 33.24	0.321
WBC, mean ± SD, 10⁹/L	2.89 ± 1.65	3.07 ± 1.85	0.596
Hb , mean ± SD, g/dL	104.16 ± 26.95	95.34 ± 28.14	1.000
PLT, mean ± SD, 10⁹/L	40.32 ± 7.74	38.24 ± 9.18	0.214
TBIL, mean ± SD, μmol/L	19.21 ± 9.76	20.88 ± 12.66	0.454
AST, mean ± SD, U/L	34.93 ± 21.26	35.89 ± 15.08	0.779
ALT, mean ± SD, U/L	31.14 ± 23.91	29.41 ± 15.28	0.637
BUN, mean ± SD, mmol/L	5.93 ± 2.25	5.38 ± 1.95	0.168
CER, mean ± SD, μmol/L	72.32 ± 17.63	71.15 ± 19.81	0.748

ALT: Alanine aminotransferase; AST: Aspartate transaminase; BUN: Urea nitrogen; CER: Creatinine; Hb: Hemoglobin; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MLSD: Modified laparoscopic splenectomy and azygoportal disconnection; OSD: Open splenectomy and azygoportal disconnection; PLT: Platelet; WBC: White blood cell.

Table 2 Intraoperative and postoperative characteristics of the modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection groups

Variable	MLSD (n = 44)	OSD (n = 71)	P value
Operation time, median (range), min	210 (140-390)	180 (110-300)	< 0.0001
Estimated blood loss, median (range), mL	150 (50-800)	300 (50-1200)	< 0.0001
Blood transfused, median (range), mL	0 (0-400)	0 (0-700)	0.024
VAS pain score on the first day, mean ± SD	2.50 ± 0.85	5.06 ± 1.08	< 0.0001
Time to first oral intake, mean ± SD, d	1.52 ± 0.63	2.76 ± 0.62	< 0.0001
Time to first flatus, mean ± SD, d	2.36 ± 0.97	3.18 ± 1.00	0.0004
Time to off-bed activity, mean ± SD, d	2.59 ± 0.69	5.96 ± 0.93	< 0.0001
Postoperative hospital stay, median (range), d	10 (7-18)	15 (7-28)	< 0.0001
Perioperative complications, n	7	26	0.017
Incision complications	0	9	0.035
Incision hernia	0	1
Superficial SSI	0	5
Deep SSI	0	3
Pneumonia	0	3	0.436
Organ space SSI	0	2	0.697
Emergency operation for bleeding	0	3	0.436
Pancreatic fistula	2	1	0.672
Asymptomatic portal vein thrombosis	5	8	1.000

MLSD: Modified laparoscopic splenectomy and azygoportal disconnection; OSD: Open splenectomy and azygoportal disconnection; VAS: Visual analog scale; SSI: Surgical site infection.

Table 3 Postoperative fever and white blood cell counts of the modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection groups

Variable	MLSD (n = 44)	OSD (n = 71)	P value
Postoperative fever, mean ± SD, d	4.09 ± 3.16	6.89 ± 3.55	< 0.0001
No fever, n	7	2	0.029
WBC 0 d, mean ± SD, 10⁹/L	2.89 ± 1.65	3.07 ± 1.85	0.596
WBC 1 d, median (range), 10⁹/L	11.45 (5.2-17.4)	16.9 (6.1-33.90)	< 0.0001
WBC 3 d, mean ± SD, 10⁹/L	11.63 ± 3.29	13.72 ± 4.67	0.011
WBC 7 d, median (range), 10⁹/L	8.4 (5-23.1)	9.5 (4.9-38)	0.035
Normal WBC, 1 d, n	15	3	< 0.0001
Normal WBC, 3 d, n	14	10	0.023
Normal WBC, 7 d, n	36	39	0.003

MLSD: Modified laparoscopic splenectomy and azygoportal disconnection; OSD: Open splenectomy and azygoportal disconnection; Postoperative fever, the number of days of postoperative body temperature > 38.0 °C; WBC: White blood cell count; day 0: Day of admission; day 1: Postoperative day 1; day 3: Postoperative day 3; day 7: Postoperative day 7.

Table 4 Postoperative liver and renal functions of the modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection groups

Variable	MLSD (n = 44)	OSD (n = 71)	P value
AST 1 d, mean ± SD, U/L	57.32 ± 27.89	87.14 ± 135.13	0.152
AST 3 d, mean ± SD, U/L	33.84 ± 22.16	50.86 ± 43.83	0.018
AST 7 d, mean ± SD, U/L	25.66 ± 11.28	33.63 ± 16.32	0.005
ALT 1 d, mean ± SD, U/L	40.14 ± 18.81	61.66 ± 105.43	0.183
ALT 3 d, mean ± SD, U/L	31.93 ± 25.21	46.93 ± 56.60	0.100
ALT 7 d, mean ± SD, U/L	21.14 ± 12.63	29.68 ± 17.36	0.003
BUN 1 d, mean ± SD, mmol/L	5.52 ± 1.76	6.54 ± 2.33	0.014
BUN 3 d, mean ± SD, mmol/L	6.63 ± 2.20	7.33 ± 2.85	0.171
BUN 7 d, mean ± SD, mmol/L	4.76 ± 2.02	5.52 ± 2.21	0.069
CER 1 d, mean ± SD, μmol/L	75.27 ± 16.22	84.99 ± 20.92	0.010
CER 3 d, mean ± SD, μmol/L	59.75 ± 16.64	66.04 ± 19.08	0.074
CER 7 d, mean ± SD, μmol/L	60.88 ± 13.92	60.83 ± 16.17	0.986

ALT: Alanine aminotransferase; AST: Aspartate transaminase; BUN: Blood urea nitrogen; CER: Creatinine; MLSD: Modified laparoscopic splenectomy and azygoportal disconnection; OSD: Open splenectomy and azygoportal disconnection; day 1: Postoperative day 1; day 3: Postoperative day 3; day 7: Postoperative day 7.

Table 5 Perioperative C-reactive protein, interleukin-6, and procalcitonin concentrations of the modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection groups

Variable	MLSD (n = 44)	OSD (n = 71)	P value
CRP day 0, median (range), mg/L	1.03 (0.02-49.21)	0.96 (0.03-13.32)	0.715
CRP day 1, mean ± SD, mg/L	28.39 ± 16.30	36.86 ± 12.86	0.002
CRP day 3, mean ± SD, mg/L	92.64 ± 53.16	114.06 ± 44.37	0.022
CRP day 7, mean ± SD, mg/L	41.14 ± 27.61	52.49 ± 29.70	0.043
IL-6 day 0, mean ± SD, pg/mL	6.14 ± 5.61	6.60 ± 7.26	0.715
IL-6 day 1, mean ± SD, pg/mL	8.09 ± 6.97	11.78 ± 9.18	0.024
IL-6 day 3, mean ± SD, pg/mL	7.65 ± 6.95	10.84 ± 8.42	0.037
IL-6 day 7, mean ± SD, pg/mL	6.58 ± 5.66	9.83 ± 8.26	0.024
PCT day 0, mean ± SD, ng/mL	0.45 ± 0.25	0.47 ± 0.27	0.722
PCT 1 d, median (range), ng/mL	0.97 (0.36-3.2)	1.96 (0.54-10.08)	< 0.0001
PCT 3 d, median (range), ng/mL	0.795 (0.3-2.67)	1.45 (0.6-4.88)	< 0.0001
PCT 7 d, median (range), ng/mL	0.5 (0.28-4.01)	0.77 (0.38-5.87)	< 0.0001

CRP: C-reactive protein; IL-6: Interleukin-6; MLSD: Modified laparoscopic splenectomy and azygoportal disconnection; OSD: Open splenectomy and azygoportal disconnection; PCT: Procalcitonin; day 0: Day of admission; day 1: Postoperative day 1; day 3: Postoperative day 3; day 7: Postoperative day 7.

Citation: Jiang GQ, Chen P, Qian JJ, Yao J, Wang XD, Jin SJ, Bai DS. Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection. World J Gastroenterol 2014; 20(27): 9146-9153
URL: https://www.wjgnet.com/1007-9327/full/v20/i27/9146.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i27.9146