Prospective Comparative Therapies for Portal Hypertension Using Laparoscopy and Open Azygoportal Disconnection

Background Laparoscopy azygoportal disconnection maybe an alternative to open azygoportal disconnection on portal hypertension, the paper aimed to compare clinical effects of laparoscopy or open azygoportal disconnection on portal hypertension, and to discuss the methodology, safety, and effectiveness of laparoscopic splenectomy combined with devascularization of the lower
esophagus and upper stomach.

Methods Eighty patients (from January of 2002 to April of 2009) with portal hypertension, secondary hypersplenism, or bleeding from the upper alimentary tract were randomly assigned into 2 groups, either treated with laparoscopic splenectomy combined with devascularization of the lower esophagus and upper stomach or open azygoportal disconnection. The 2 groups were compared on the aspects of sex, age, Child grading, operation length, bleeding amount, hepatic function, passage of gas by anus, total bilirubin, prothrombin time, and C- reactive protein.

Results The operation using laparoscopic splenectomy combined with devascularization of the lower esophagusand upper stomach on 40 cases were all successful, without a single case receiving conversion from laparoscopic to open surgery. There is no death occurred in both groupsThere were no significant difference between 2 groups with aspect to sex, age, Child grading,
pre- and post-operation PT. In comparison to open surgery, laparoscopy needed a longer operation time with less complication, although not statistically significant( P>0.05). Laparoscopygroup had a significant reduced bleeding amount (P<0.001), earlier passage of gas by anus (P<0.05), shorter in-hospital time (P<0.05), faster recovery based on total bilirubin measurement on day 1, 3, and 7 postoperation(P<0.05),faster reduction of CRP on day 3 after surgery (P<0.05), lower response to trauma, than open surgery.

Conclusion laparoscopic splenectomy combined with devascularization of the lower esophagus and upper stomach is safe and effective, and provides an alternative choice for treating portal hypertensionand and bleeding from the upper alimentary tract.


Session: Poster

Program Number: P516

View Poster

« Return to SAGES 2010 abstract archive