Laparoscopic splenectomy and devascularization for massive splenomegaly in portal hypertensive patients: a retrospective study of a single surgical team's experience with 6-year follow-up data.

Background: In China, laparoscopic splenectomy and esophagogastric devascularization (LSED) are effective and safe tools that are used to treat esophageal-fundic variceal bleeding with portal hypertension (PHT) with minimal trauma; however, due to the increased difficulty of operation, their application in massive splenomegaly (MS) remains limited. This study sought to determine the efficacy and safety of LSED in treating MS patients with PHT.

Methods: The data of 124 patients who underwent LSED by a single surgical team at our department from January 2015 to December 2020 were retrospectively analyzed. The characteristics of the patients, perioperative parameters, and long-term follow-up data were examined.

Results: A total of 61 MS and 63 mild-to-moderate splenomegaly (MMS) patients underwent LSED. Much larger spleen and significant lower of white blood cells and platelets was found in MS group compared the MMS group preoperation (P<0.05). The MS group had a significantly longer operation time (P=0.009), more blood loss (P=0.003), and more abdominal drainage days (P=0.017) than the MMS group. Four patients in the MS group and 0 patients in the MMS group were converted to open surgery. No significant difference was found between the 2 groups in terms of postoperative complications. Nine patients in the MMS group and 10 in the MMS group experienced recurrent bleeding in the follow-up period, but no significant differences were observed in terms of recurrent bleeding and overall survival (OS) between the 2 groups.

Conclusions: LSED can be used to treat MS patients with PHT under careful perioperative management. For experienced surgeons, LSED is a safe, feasible, and minimally invasive procedure with satisfactory long-term outcomes that can be used to treat MS patients with PHT.

Keywords: Laparoscopic splenectomy (LS); massive splenomegaly (MS); devascularization; portal hypertension (PHT).