Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection

World J Gastroenterol. 2014 Jul 21;20(27):9146-53. doi: 10.3748/wjg.v20.i27.9146.

Abstract

Aim: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy or open splenectomy and azygoportal disconnection for portal hypertension.

Methods: This study included 44 patients who underwent modified laparoscopic splenectomy and azygoportal disconnection (MLSD) and 71 who underwent open procedures for portal hypertension. Blood samples were collected before surgery and on days 1, 3, and 7 after surgery. Markers of liver and renal function, C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) were measured, and perioperative variables were compared between the two groups.

Results: The modified laparoscopic group showed significantly better and faster recovery, better liver and renal function, and fewer complications than the open group. CRP, IL-6, and PCT concentrations on postoperative days 1, 3, and 7 were significantly lower in the modified laparoscopic group than in the open group.

Conclusion: MLSD was associated with lower inflammatory immune responses, less impairment of liver and renal function, and faster and better recovery.

Keywords: Azygoportal disconnection; Inflammatory response; Laparoscopy; Portal hypertension; Splenectomy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Azygos Vein / physiopathology
  • Azygos Vein / surgery*
  • Biomarkers / blood
  • Female
  • Humans
  • Hypertension, Portal / blood
  • Hypertension, Portal / diagnosis
  • Hypertension, Portal / physiopathology
  • Hypertension, Portal / surgery*
  • Inflammation / blood
  • Inflammation / etiology
  • Inflammation / prevention & control
  • Inflammation Mediators / blood
  • Kidney / physiopathology
  • Laparoscopy* / adverse effects
  • Liver / physiopathology
  • Male
  • Middle Aged
  • Portal Pressure
  • Portal Vein / physiopathology
  • Portal Vein / surgery*
  • Recovery of Function
  • Retrospective Studies
  • Splenectomy / adverse effects
  • Splenectomy / methods*
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Inflammation Mediators