Laparoscopic Splenectomy and Azygoportal Disconnection With Intraoperative Splenic Blood Salvage

Yuedong Wang, MD PhD, Yun Ji, MD, Yangwen Zhu, MD, Zhijie Xie, MD, Xiaoli Zhan, MD. Department of General Surgery, Zhejiang Provincial People’s Hospital, Zhejiang China

Background: Intraoperative blood salvage can reduce or avoid perioperative allogeneic blood transfusion. To salvage the blood in the portal hypertension-induced enlarged spleen becomes an issue of concern during devascularization surgery because an enlarged spleen accommodates a large red cell pool. We report 20 cases of laparoscopic splenectomy and azygoportal disconnection and present the advantages of the use of intraoperative splenic blood salvage during the procedure.
Methods: A total of 20 cirrhotic patients with esophagogastric variceal bleeding refractory to treatment with beta-blockers and endoscopic therapy were studied. Laparoscopic splenectomy and azygoportal disconnection was performed. During the procedure, an intraoperative autologous blood salvage device recovered the splenic blood. The perioperative data was recorded from various viewpoints.
Results: The operative time was 3.1±0.3 h, and the blood loss was 70.5±32.5 ml. The excised and morcellated spleen weight was 826.0±155.1 g. The volume of blood autotransfused was 541.0 ±150.4mL. No patients received perioperative allogeneic blood transfusion. There were no significant complications either intraoperatively or postoperatively. The hemoglobin value increased from 9.3±0.8 g/dl to 11.5±1.1 g/dl at postoperative day 1 (P<0.01). During a postoperative follow-up period of 18.0± 9.0 months in 18 patients, neither esophagus variceal bleeding nor encephalopathy has recurred.
Conclusion: Laparoscopic splenectomy and azygoportal disconnection is a feasible, effective, and safe surgical method for the treatment of bleeding portal hypertension. Intraoperative splenic blood salvage can avoid the risk associated with allogeneic transfusion during the procedure, with an advantage of significantly increased postoperative hemoglobin levels.
Keywords Blood salvage . Devascularization . Laparoscopy . Liver cirrhosis . Portal hypertension