Outcome of laparoscopic splenectomy with sandwich treatment including pericardial devascularization and limited portacaval shunt for portal hypertension due to liver cirrhosis

To investigate the feasibility, effectiveness, and safety of a combination therapy of laparoscopic splenectomy (LS) with pericardial devascularization (PD) (laparoscopic Hassab's procedure) with or without limited portacaval shunt (LPS) for patients with portal hypertension due to liver cirrhosis. During September 2008 to April 2012, 42 patients underwent a combined treatment of LS with PD in our hospital. Of these subjects, 16 patients had an assessment of free portal vein pressure of more than 3.92-4.4 kPa and underwent a further limited LPS. Information on patients' demographics, diagnosis, and indication of splenectomy and perioperative variables was collected and analyzed. All patients successfully survived the operation, and 2 patients required an intraoperative conversion to open splenectomy because of intraoperative bleeding. For patients with LS plus PD, the mean operating time was 145 minutes, and the estimated blood loss was 146.2 mL. For patients who received an additional LPS, the total operating time was 232 minutes, and the established blood loss was 338.1 mL. The mean postoperative hospital stay was 11.7 and 12.3 days, respectively. Postoperative complications occurred in 1 patient who suffered gastric leakage, who received a re-operation and recovered later, and in 5 patients who experienced ascites, who received conserved medical treatment. During the follow-up, 2 patients had esophageal variceal bleeding 3 months and 1 year, respectively, after surgery. One patient had an encephalopathy 1 year after surgery, and 2 patients suffered a portal vein thrombosis without any clinical symptom. All of them were treated with conservation therapy. Two patients died 24-36 months and more than 36 months after surgery, because of liver failure. The other patients recovered well. We concluded that being only slightly invasive, the sandwich strategy treatment of LS with PD and LPS is feasible, effective, and safe for patients with portal hypertension due to liver cirrhosis.