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

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

World J Gastrointest Surg. 2023 Aug 27;15(8):1684-1692. doi: 10.4240/wjgs.v15.i8.1684.

Authors

Rui-Zhao Qi¹, Zhi-Wei Li², Zheng-Yao Chang¹, Wei-Hua Chang¹, Wen-Lei Zhao¹, Chuan Pang¹, Ying Zhang¹, Xing-Long Hu¹, Feng Liang³

Affiliations

¹ Department of General Surgery, 5 Medical Center, Chinese PLA General Hospital, Beijing 100039, China.
² Department of Hepatobiliary, The 3 People's Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China.
³ Department of General Surgery, 5 Medical Center, Chinese PLA General Hospital, Beijing 100039, China. lfpeakcool@126.com.

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