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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Elective Splenectomy Combined with Modified Hassab's or Sugiura Procedure for Portal Hypertension in Decompensated
Ya-Wu Zhang1,2,3, Feng-Xian Wei1,2,3, Zhen-Gang Wei1,2,3
1Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China.
Insights
Modified Sugiura procedure showed a trend towards reduced deadly variceal bleeding compared to modified Hassab's procedure in nonshunting surgery for portal hypertension. Further research is needed to confirm these findings in decompensated cirrhosis patients.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Clinical Trials
Background:
- Portal hypertension is a significant complication of decompensated cirrhosis.
- Nonshunting surgical procedures, including modified Hassab's and Sugiura procedures, are employed in China for managing portal hypertension.
- Hypersplenism often accompanies decompensated cirrhosis, necessitating interventions like splenectomy.
Purpose of the Study:
- To compare the efficacy and safety of modified Hassab's and Sugiura procedures in patients with decompensated cirrhosis and hypersplenism.
- To evaluate the rates of postoperative mortality, morbidity, and variceal bleeding following these nonshunting surgical techniques.
- To assess long-term survival rates and bleeding-related outcomes.
Main Methods:
- A retrospective comparative analysis of 172 elective patients undergoing splenectomy combined with either modified Hassab's (n=91) or Sugiura (n=81) procedure.
- Data collection focused on postoperative mortality, morbidity, variceal bleeding events, and survival rates at 1, 3, and 5 years.
- Statistical analysis was performed to compare outcomes between the two surgical groups.
Main Results:
- No intraoperative deaths or variceal bleeding occurred during hospitalization in either group.
- Postoperative mortality rates were comparable: 4.4% for Hassab's group and 3.7% for Sugiura group (P > 0.05).
- Five-year survival rates were 71.43% for Hassab's and 75.31% for Sugiura group (P > 0.05). A trend towards reduced deadly variceal bleeding was observed with the Sugiura procedure (P = 0.11).
Conclusions:
- Elective splenectomy combined with the modified Sugiura procedure may offer a reduced trend in deadly variceal bleeding compared to the modified Hassab's procedure.
- While not statistically significant, the observed trend warrants further investigation.
- Larger scale, prospective studies are recommended to definitively establish the comparative efficacy and safety of these procedures for managing portal hypertension.
Objective:
Portal hypertension is a major complication of decompensated cirrhosis. In China, modified Hassab's and Sugiura procedure are the two major methods of nonshunting surgery. This study aims to compare the efficacy and safety of the two procedures for portal hypertension.
Method:
Between January 1994 and December 2009, 172 elective patients diagnosed with decompensated cirrhosis with significant hypersplenism adopted elective splenectomy for hypersplenism, and also modified Hassab's (n = 91) or Sugiura (n = 81) procedure was additionally performed to reduce the risk of variceal bleeding. Postoperative mortality and morbidity data were collected, and a retrospectively comparative analysis was conducted.
Results:
All of the patients were treated successfully without death during operation, and no variceal bleeding occurred during hospitalization. There were 4 (4.4%) deaths in Hassab's group and 3 (3.7%) deaths in Sugiura group postoperatively (P > 0.05). During follow-up, the survival rate was 90.2%, 82.42%, and 71.43% in Hassab's group and 96.29%, 81.48%, and 75.31% in Sugiura group in 1, 3, and 5 years (P > 0.05). There were 22/71 and 12/63 patients in each groups who suffered no deadly variceal bleeding (P = 0.11). Bleeding related death and no bleeding related death occurred in 7/23 and 3/13 patients in each group (P = 0.26 and 0.14, respectively).
Conclusion:
Elective splenectomy combined with modified Sugiura procedure seemed to be associated with a reduced trend of no deadly variceal bleeding compared with Hassab's procedure. As statistical significance was not found, further large scale and prospective study was warranted.
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