Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function

doi:10.4240/wjgs.v15.i8.1684

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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, 5^th Medical Center, Chinese PLA General Hospital, Beijing 100039, China

Zhi-Wei Li, Department of Hepatobiliary, The 3^rd 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.

Corresponding author: Feng Liang, PhD, Doctor, Department of General Surgery, 5^th 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

ARTICLE HIGHLIGHTS

Research background

In addition to the resulting adverse effects on portal blood entering the liver that lead to decreased liver function in patients, portal hypertension (PH) can also induce liver hemodynamic changes that are closely related to many complications, warranting more clinical attention to this disease.

Research motivation

To help people gain a better understanding of the clinical effect of total laparoscopic splenectomy (TLS) in the treatment of PH.

Research objectives

The clinical effect of TLS on PH and its effect on liver hemodynamics and liver function are analyzed through case discussion and literature review.

Research methods

The clinical efficacy, surgical indexes, safety, liver hemodynamics, and liver function were compared between the observation group (n = 100) receiving TLS and the reference group (n = 99) receiving open splenectomy.

Research results

Although the operation time was significantly longer compared with the reference group, the overall response rate was significantly higher and the intraoperative blood loss and incidence of postoperative complications were significantly lower in the observation group. The detection of liver hemodynamics and liver function revealed significantly lower liver hemodynamics (blood vessel diameter, blood flow velocity and blood flow volume) and liver function indexes in the observation group vs the reference group 2 wk after surgery.

Research conclusions

For the treatment of PH, TLS is significantly better than open splenectomy in clinical efficacy, reducing the risk of postoperative complications in patients and improving their liver hemodynamics and liver function.

Research perspectives

In addition to clinical efficacy, we believe that future research and exploration of PH could also focus on the influence on liver hemodynamics and liver function, so as to further screen and optimize the clinical treatment of PH and improve patient outcomes.