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Updated: Aug 24, 2026

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
04:00

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Published on: November 15, 2024

Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone?

Chong-En Xu1, Shu-Guang Zhang, Zhen-Hai Yu

  • 1The Queensland Liver Transplant Service, Princess Alexandra Hospital, Ipswich Road, Woolloongabba QLD 4102, Australia.

Journal of Hepato-Biliary-Pancreatic Surgery
|May 6, 2004
PubMed

Insights

Combined pericardial devascularization (PCDV) and proximal splenorenal shunt (PSRS) effectively reduces portal venous flow and pressure in cirrhotic patients with variceal bleeding. This combined approach offers a promising surgical option for managing portal hypertension.

Area of Science:

  • Hepatology
  • Surgical Gastroenterology
  • Vascular Surgery

Background:

  • Portal hypertension in cirrhotic patients often leads to variceal bleeding.
  • Surgical interventions aim to reduce portal pressure and prevent rebleeding.

Purpose of the Study:

  • To evaluate the efficacy of pericardial devascularization (PCDV) plus proximal splenorenal shunt (PSRS) in managing cirrhotic patients with portal hypertension and variceal bleeding.
  • To assess the hemodynamic effects of PCDV, PSRS, and combined PCDV + PSRS on the portal system using duplex sonography.

Main Methods:

  • Ninety-nine cirrhotic patients with a history of variceal bleeding were divided into three groups: PSRS, PCDV, and PCDV + PSRS.
  • Doppler color-flow imaging was used to measure hemodynamic parameters of the portal system perioperatively.

Main Results:

  • PSRS significantly reduced portal venous flow (PVF) by 57% and free portal pressure (FPP) by 52% (P < 0.01).
  • PCDV showed a modest reduction in PVF (8%, P > 0.05) and FPP (19%, P < 0.05).
  • PCDV + PSRS resulted in significant reductions in PVF (36%) and FPP (34%) (P < 0.05), with outcomes between the individual procedures and statistically significant differences among all groups (P < 0.05).

Conclusions:

  • Combined PCDV + PSRS significantly decreases portal venous flow and pressure while maintaining hepatopedal flow.
  • The combined approach offers a potentially safer and more effective treatment for cirrhotic patients with portal hypertension and variceal bleeding compared to either procedure alone.
Abstract

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