Partial splenectomy and pericardial devascularization for symptomatic patients with portal hypertension: a...

The dilemma of current treatments for symptomatic patients with portal hypertension is how to resolve the problems of the varices and hypersplenism simultaneously and meanwhile preserve the splenic function. Partial splenectomy and pericardial devascularization is a potential alternative to currently used approaches, but it is incompletely defined. This study aimed to evaluate the efficacy and safety of partial splenectomy and pericardial devascularization.

This study followed 132 symptomatic patients with portal hypertension who underwent partial splenectomy and pericardial devascularization in the General Surgery Department of the Fifth Medical Center of PLA General Hospital from 2016 to 2023. Clinical, laboratory, endoscopic examination and imaging data were collected and compared between preoperative and postoperative levels at intervals using a mixed linear model.

All 132 patients with portal hypertension successfully underwent partial splenectomy and pericardial devascularization without intraoperative uncontrolled massive bleeding or death. Leucocyte and platelet counts increased to normal levels at intervals from 1 year to ≥ 4 years postoperatively. Among the patients followed for six months postoperatively, 23 (52.27%) showed improvement in esophagogastric varices, 19 (43.18%) had no significant changes in their condition, and 2 (4.55%) experienced worsening of the varices. At subsequent follow-ups, the majority of patients either showed improvements or no change in their esophagogastric varices, with only a small fraction experiencing worsening of the condition. The splenic remnant survived in most patients, and regrowth was very limited postoperatively, while 13 (9.85%) patients splenic remnant necrosis during follow-up. Liver failure was observed in 5 (3.79%) patients postoperatively, and 3 (2.27%) of them died perioperatively. Portal vein thrombosis was found in 90 (75%) patients the 7th days after surgery. With the progression of follow-up time, the proportion of patients with postoperative portal vein system thrombosis decreased over time. 3 (2.27%) patients experienced postoperative abdominal bleeding, which improved after emergency surgery for hemostasis.

Partial Splenectomy and Pericardial Devascularization appears to be a safe and effective approach to treat symptomatic patients with Portal Hypertension, while preserving the potential function of the spleen.