Laparoscopic splenectomy for portal hypertension secondary to liver cirrhosis: Ligasure combined with ultrasound scalpel versus ultrasound scalpel

Mingjun Wang, Xin Wang, Hua Zhang, Yunqiang Cai, Bing Peng. West China Hospital

Introduction: Hypersplenism and enriched collateral circulation due to liver cirrhosis increase the risk of hemorrhage,which is the leading cause of conversion to laparotomy. Recently, a novel vessel sealing system, Ligasure, has been widely used in laparoscopic surgeries. The purpose of this study is to compare two different instruments for laparoscopic splenectomy in liver cirrhotic patients with portal hypertension.

Methods: From 2004 to 2014, a total of 64 liver cirrhotic patients with portal hypertension receiving laparoscopic splenectomy were retrospectively reviewed. The patients were divided into Group 1 (n=23), in which splenectomy was performed using ultrasound scalpel alone, and Group 2 (n=41), in which Ligasure combined with ultrasound scalpel was applied. The demographic characteristics, and perioperative details were collected and compared between the two groups.

Results: No significant differences were detected regarding age, gender, Child-Pugh class, ASA, splenic length between the two groups. Compared with Group 1, patients in Group 2 required shorter operative time (164±54 min vs. 209±58 min, P=0.003), and suffered less intraoperative blood loss (83±45mL vs. 275±417mL, P=0.038). Four patients in Group 1 had a blood loss of over 500 mL with 2 conversions, while all patients in Group 2 suffered a blood loss of less than 300 mL without conversions. The parameters including postoperative complications (17.4% vs. 9.8%, P=0.305), time to oral intake (28.1±5.6 h vs. 27.9±6.7 h,P=0.906), and postoperative hospital stays (8.3±3.1d vs. 8.2±2.6 d,P=0.935) were comparable in the couple groups.

Conclusion: The application of Ligasure combined with ultrasound scalpel in laparoscopic splenectomy in patients with portal hypertension secondary to liver cirrhosis results in a decrease of blood loss and a gain of operative time. Therefore, this method should be recommended in a series of such laparoscopic surgeries.