Concomitant Laparoscopic Perisplenic Artery Ligation Facilitates Surgery for Hepatobiliary Disease Coexisting with Portal Hypertension.

BACKGROUND

Although liver cirrhosis with portal hypertension (PH) contributes significantly to morbidity and mortality in abdominal surgery, many authors still consider this disease as an indication for surgery. In many reports, however, numerous treatment modalities focus on hypersplenism secondary to PH, irrespective of splenomegaly and PH. The proven benefits of laparoscopy seem especially applicable to patients with this complex disease. This study evaluates the safety and efficacy of laparoscopic perisplenic artery ligation (SAL) in patients with hepatobiliary disease and PH.

METHODS

From July 2004 to May 2012, the medical records of all patients with hepatobiliary disease in the context of PH at the authors' institutes, including patient demography, operative outcomes, and change of liver function, were retrospectively reviewed.

RESULTS

A total of 101 patients were included in the series: 85 patients with cirrhotic Child A, B class, who underwent no intervention (Control group n = 22), splenectomy (SP group n = 29), laparoscopic SAL (SAL-1 group, n = 34) for splenomegaly, and 16 patients with cirrhotic Child C class, who only underwent laparoscopic SAL (SAL-2 group, n = 16). Among these patients, both laparoscopic SAL and open SP for splenomegaly were available to decrease morbidity rate, loss of bleeding, and improve liver function, whereas laparoscopic SAL had a lower rate of surgical-related complications.

CONCLUSIONS

Although technically challenging in patients with hepatobiliary disease coexisting with PH, the present series demonstrated the safety and feasibility of laparoscopic SAL, even facilitating simultaneous surgery for hepatobiliary diseases, with a clear advantage over SP and no intervention.