Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1684-1692
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1684
Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function
Rui-Zhao Qi, Zhi-Wei Li, Zheng-Yao Chang, Wei-Hua Chang, Wen-Lei Zhao, Chuan Pang, Ying Zhang, Xing-Long Hu, Feng Liang
Rui-Zhao Qi, Zheng-Yao Chang, Wei-Hua Chang, Wen-Lei Zhao, Chuan Pang, Ying Zhang, Xing-Long Hu, Feng Liang, Department of General Surgery, 5th Medical Center, Chinese PLA General Hospital, Beijing 100039, China
Zhi-Wei Li, Department of Hepatobiliary, The 3rd People’s Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China
Author contributions: Qi RZ and Li ZW contributed equally to this work and are co-first authors; Qi RZ and Li ZW contributed to the research design and thesis writing; Chang ZY, Liang F and Chang WH collected and analyzed the data; Qi RZ, Li ZW, Zhao WL and Pang YZ contributed to the data collection; Liang F overall supervise the study; all authors contributed to the article and approved the submitted version.
Institutional review board statement: The study was reviewed and approved by the Chinese PLA General Hospital Institutional Review Board (Approval No. 2010068D).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Liang, PhD, Doctor, Department of General Surgery, 5th Medical Center, Chinese PLA General Hospital, No. 8 Dongdajie, Fengtai District, Beijing 100039, China. lfpeakcool@126.com
Received: April 6, 2023
Peer-review started: April 6, 2023
First decision: April 19, 2023
Revised: May 16, 2023
Accepted: June 6, 2023
Article in press: June 6, 2023
Published online: August 27, 2023
Processing time: 141 Days and 2.9 Hours
Abstract
BACKGROUND

The liver hemodynamic changes caused by portal hypertension (PH) are closely related to various complications such as gastroesophageal varices and portosys-temic shunts, which may lead to adverse clinical outcomes in these patients, so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.

AIM

To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function.

METHODS

Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups.

RESULTS

The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences.

CONCLUSION

TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.

Keywords: Total laparoscopic splenectomy; Open splenectomy; Portal hypertension; Clinical efficacy; Hepatic hemodynamics and liver function

Core Tip: Portal hypertension (PH) can bring adverse effects to patients such as hepatic hemodynamic changes and decreased liver function. We propose and demonstrate that total laparoscopic splenectomy, although comparable to open splenectomy in clinical efficacy, safety, and effects on hepatic hemodynamics and liver function in patients with PH, has the advantage of less intraoperative blood loss.