Related Experiment Video

Updated: Jul 16, 2025

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

238

Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for

Wei-Li Qi1, Jun Wen1,2, Tian-Fu Wen1

  • 1Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.

World Journal of Gastrointestinal Surgery
|September 13, 2023
PubMed

Insights

Splenectomy plus pericardial devascularization (SPD) offers better survival and lower risks of liver dysfunction and liver cancer compared to transjugular intrahepatic portosystemic shunt (TIPS) for treating esophagogastric variceal bleeding in hepatitis B cirrhosis patients. Variceal rebleeding rates were similar between the two treatments.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Esophagogastric variceal bleeding (EGVB) is a severe complication in patients with hepatitis B virus (HBV)-related cirrhosis and portal hypertension.
  • Splenectomy plus pericardial devascularization (SPD) and transjugular intrahepatic portosystemic shunt (TIPS) are established treatments for EGVB.
  • Comparative data on the efficacy and safety of SPD versus TIPS for EGVB in HBV-related cirrhosis is limited.

Purpose of the Study:

  • To compare the long-term prognosis of SPD versus TIPS in patients with HBV-related cirrhosis and acute EGVB.
  • To evaluate overall survival, variceal rebleeding (VRB) rates, liver function, and hepatocellular carcinoma (HCC) incidence after SPD and TIPS.
  • To assess treatment outcomes following endoscopic therapy failure or as secondary prophylaxis for VRB.

Main Methods:

  • Retrospective cohort study of 318 patients with HBV-related cirrhosis and EGVB.
  • Propensity score-matched analysis (PSM) to control for confounding factors.
  • Kaplan-Meier and Cox regression analyses to compare survival, VRB, liver function, and HCC incidence.

Main Results:

  • After PSM, SPD was associated with significantly better overall survival (P=0.01).
  • SPD demonstrated lower rates of abnormal liver function (P<0.001) and HCC incidence (P=0.02) compared to TIPS.
  • No significant difference in variceal rebleeding (VRB) rates was observed between the SPD and TIPS groups (P=0.09).

Conclusions:

  • SPD is associated with superior postoperative survival and reduced risks of liver dysfunction and HCC compared to TIPS for EGVB management in HBV-related cirrhosis.
  • Both SPD and TIPS are effective in preventing recurrent variceal bleeding, with no significant difference between the two procedures.
  • SPD may offer a better quality of survival for patients undergoing treatment for acute EGVB or secondary prophylaxis of VRB.
Abstract

Keywords:
Esophagogastric variceal bleedingLiver cirrhosisPericardial devascularizationPortal hypertensionSplenectomyTransjugular intrahepatic portosystemic shunt

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