Xiaoli Zhan

Laparoscopic splenectomy in portal hypertension: a single-surgeon 13-year experience

BackgroundAlthough laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude LS are not clearly defined. Portal hypertension from liver cirrhosis still is a contraindication to LS in the clinical practice guidelines of the European Association for Endoscopic Surgery published in 2008. This study aimed to evaluate the feasibility of LS for hypersplenism secondary to liver cirrhosis and portal hypertension.MethodsThe study retrospectively analyzed 206 laparoscopic splenectomies performed for a variety of indications over 13xa0years. According to diagnosis, the patients were divided into group A (hypersplenism secondary to liver cirrhosis and portal hypertension, nxa0=xa096) and group B (hematologic and other disorders, nxa0=xa0110). A detailed review of medical records was conducted. The perioperative data for the two groups were compared including patient characteristics, diagnosis, operative details, complication rates, and postoperative hospital stay.ResultsLaparoscopic splenectomy was completed for 201 patients. Conversion from laparoscopic to open surgery was necessary for 5 patients (2.4%) because of hemorrhage, and 26 patients (12.6%) had complications. There were significant differences between groups A and B in terms of mean operation time (2.8 vs. 2.1xa0h), complication rates (17.7% vs. 8.2%), and postoperative stay (7.1 vs. 4.7xa0days). However, the two groups showed no significant differences with respect to intraoperative blood loss, blood transfusion, and conversion rate.ConclusionLaparoscopic splenectomy is a feasible, effective, and safe surgical procedure for patients who require splenectomy. Hypersplenism secondary to cirrhosis and portal hypertension should not be considered contraindications for LS.

Comparison of short-term outcomes between laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy

BackgroundLaparoscopic greater curvature plication (LGCP) is an emerging restrictive bariatric procedure that successfully reduces the gastric volume by plication of the gastric greater curvature. The aim of this prospective nonrandomized study was to compare short-term outcomes and associated complications between LGCP and laparoscopic sleeve gastrectomy (LSG).MethodsFrom January 2011 to November 2011, a total of 39 patients were allocated to undergo either LGCP (nxa0=xa019) or LSG (nxa0=xa020). Data on the operative time, complications, hospital stay, overall cost of LSG and LGCP, body mass index loss (BMIL), percentage of excess weight loss (%EWL), loss of appetite and improvement of comorbidities were collected during the follow-up examinations.ResultsAll procedures were completed laparoscopically. The mean operative time was 95.0xa0±xa017.4 minutes for the LGCP group and 85.5xa0±xa018.4 minutes for the LSG group (Pxa0=xa00.107). No patient required reoperation due to an early complication. One patient in the LSG group was readmitted because of gastric stenosis. The mean hospital stay was 4.2xa0±xa01.9xa0days in the LGCP group and 3.9xa0±xa01.7xa0days in the LSG group (Pxa0=xa00.595). The total cost of LSG was

Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage

7,826xa0±xa0537 compared to LGCP (

Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

3,358xa0±xa0264) (Pxa0<xa00.001). One year after surgery, the mean %EWL was 58.8xa0±xa016.7xa0% (nxa0=xa011) in the LGCP group and 80.0xa0±xa026.8xa0% (nxa0=xa011) in the LSG group (Pxa0=xa00.038). Loss of feeling of hunger was reported in 27.3xa0% LGCP patients and 72.7xa0% LSG patients (Pxa0=xa00.033) at 1xa0year after surgery. The comorbidities, including diabetes, sleep apnea and hypertension, were markedly improved in both groups 6xa0months after surgery.ConclusionsThe short-term outcomes of our study demonstrate that compared with LSG, LGCP is inferior as a restrictive procedure for weight loss, despite its significantly smaller cost. Longer follow-up and prospective comparative trials are needed to confirm the long-term outcomes of this novel procedure and make definitive conclusions.

Laparoscopic greater curvature plication: Surgical techniques and early outcomes of a Chinese experience ☆

BackgroundIntraoperative blood salvage can reduce or avoid perioperative allogeneic blood transfusion. Salvaging 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.MethodsA total of 20 cirrhotic patients with esophagogastric variceal bleeding refractory to treatment with β-blockers and endoscopic therapy were studied. Laparoscopic splenectomy with azygoportal disconnection was performed. During the procedure, an intraoperative autologous blood salvage device recovered the splenic blood. The perioperative data were recorded from various viewpoints.Results The operative time was 3.1xa0±xa00.3xa0h and the blood loss was 70.5xa0±xa032.5xa0ml. The weight of the excised and morcellated spleen was 826.0xa0±xa0155.1xa0g. The volume of autotransfused blood was 541.0xa0±xa0150.4xa0ml. No patient received a perioperative allogeneic blood transfusion. There were no significant complications either intraoperatively or postoperatively. The hemoglobin value increased from 9.3xa0±xa00.8 to 11.5xa0±xa01.1xa0g/dl at postoperative day 1 (pxa0<xa00.01). During a postoperative follow-up period of 18.0xa0±xa09.0xa0months for 18 patients, neither esophageal variceal bleeding nor encephalopathy recurred.ConclusionLaparoscopic splenectomy with 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.

Laparoscopic Versus Open Pediatric Splenectomy for Massive Splenomegaly

Since the first laparoscopic splenectomy (LS) was reported in 1991, LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign conditions. Compared with open splenectomy, fewer postsurgical complications and better postoperative recovery have been observed, but LS is contraindicated for hypersplenism secondary to liver cirrhosis in many institutions owing to technical difficulties associated with splenomegaly, well-developed collateral circulation, and increased risk of bleeding. With the improvements of laparoscopic technique, the concept is changing. This article aims to give an overview of the latest development in laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension. Despite a lack of randomized controlled trial, the publications obtained have shown that with meticulous surgical techniques and advanced instruments, LS is a technically feasible, safe, and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension and contributes to decreased blood loss, shorter hospital stay, and less impairment of liver function. It is recommended that the dilated short gastric vessels and other enlarged collateral circulation surrounding the spleen be divided with the LigaSure vessel sealing equipment, and the splenic artery and vein be transected en bloc with the application of the endovascular stapler. To support the clinical evidence, further randomized controlled trials about this topic are necessary.

Comparison of Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication Regarding Efficacy and Safety: a Meta-Analysis.

BACKGROUNDnLaparoscopic greater curvature plication (LGCP) is a novel restrictive bariatric procedure that can reduce the gastric volume by infolding the gastric greater curvature without gastrectomy. The objective of this study was to describe the surgical technique of LGCP and validate the efficacy and safety of LGCP for the treatment of obesity in obese Chinese patients with a relatively low body mass index (BMI).nnnMETHODSnTwenty-two obese patients (mean age 33.8±6.0 years; mean BMI 37.0±7.0 kg/m(2)) underwent LGCP between September 2011 and September 2012. After dissecting the greater omentum and short gastric vessels, the gastric greater curvature plication with 2 rows of nonabsorbable suture was performed under the guidance of a 32-F bougie. The data were collected during follow-up examinations performed at 1, 3, 6, and 12 months postoperatively.nnnRESULTSnAll procedures were performed laparoscopically. The mean operative time was 84.1 minutes (50-120 min), and the mean length of hospital stay was 3.8 days (2-10 d). There were no deaths or postoperative major complications that needed reoperation. The mean percentage of excess weight loss (%EWL) was 22.9%±6.9%, 38.6%±9.8%, 51.5%±13.5%, and 61.1%±15.9% at 1, 3, 6, and 12 months postoperatively. At 6 months, type 2 diabetes was in remission in 2 (50%) patients, hypertension in 1 (33.3%) patient, and dyslipidemia in 11 (78.6%) patients. Decreases in the index for homeostasis model assessment of insulin resistance (HOMA-IR) and in insulin and glucose concentrations were observed.nnnCONCLUSIONSnThe early outcomes of LGCP as a novel treatment for obese Chinese with a relatively low BMI are satisfactory with respect to the effectiveness and low incidence of major complications. Additional long-term follow-up and prospective, comparative trials are still needed.

Comparative study of laparoscopic sleeve gastrectomy with and without partial enterectomy and omentectomy.

Laparoscopic splenectomy (LS) has rapidly evolved into the technique of choice compared with open splenectomy (OS) because of the advantages of the minimally invasive approach. Splenomegaly increases the technical difficulties of LS. LS for massive splenomegaly has generally been found to fail in adults and children. With improvements in laparoscopic technique and accumulation of laparoscopic experience, however, concerns about completing the procedure in pediatric cases with even massive splenomegaly have been lowered. A retrospective review (April 1997-October 2009) of databases at 2 institutions identified 145 children undergoing splenectomy, 79 laparoscopic and 66 open. We defined splenic margin below the umbilicus or anteriorly extending over the midline as massive splenomegaly. By this definition, 22 cases of pediatric laparoscopic and 17 cases of open splenectomies for massive splenomegaly were performed. Perioperative and follow-up data of laparoscopic pediatric splenectomies were compared with those of open splenectomies, including operative time, bleeding, spleen size, complications, and hospital stay. There were no deaths, wound infections, or instances of pancreatitis. No accessory spleen was missed by laparoscopic; accessory spleens were missed in 2 patients in open splenectomies. The complication rate of laparoscopic versus open was 13.6% versus 41.2%. No subsequent surgery was necessary for dealing with complications both in laparoscopic and open series. Laparoscopic pediatric splenectomy for massive splenomegaly is a feasible, effective, and safe procedure and is associated with low morbidity and a short hospital stay.

Combined Laparoscopic and Open Technique for the Repair of Large Complicated Incisional Hernias

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP) are two restrictive bariatric procedures. Eight studies (three randomized, controlled trials, four retrospective studies, and one prospective study) with 536 patients on LSG and LGCP were included by searching PUBMED, EMBASE, and the Cochrane Library. The software Review Manager 5.3 was used to evaluate operation time, adverse events, percent excess weight loss (%EWL), resolution of obesity-related comorbidities, and postoperative hospital stay. Despite the limitations, this meta-analysis suggests that LSG is superior to LGCP in terms of providing greater %EWL at the follow-up of 3, 6, and 12xa0months and 3xa0years. LSG gains shorter postoperative hospital stay than LGCP. No significant difference was found in operation time, adverse events, and the resolution of obesity-related comorbidities.

Primary Versus Secondary Splenic Pedicle Dissection in Laparoscopic Splenectomy for Splenic Diseases

BACKGROUNDnLaparoscopic sleeve gastrectomy (LSG) is a novel bariatric surgical procedure that constitutes the first-stage procedure of laparoscopic Roux-en-Y gastric bypass in high-risk patients, the long-term results of which are unknown. Our objective was to establish whether partial enterectomy and omentectomy are necessary in addition to LSG to achieve weight loss in obese patients. The setting was a case series in a provincial hospital.nnnMETHODSnA total of 40 obese patients (29 women and 11 men) were separated into 2 equal groups according to patient choice. Group 1 underwent LSG alone, and group 2 underwent LSG plus partial enterectomy and omentectomy. The partial enterectomy left the first 100 cm of the jejunum and the last 200 cm of the ileum. The data were collected during the follow-up examinations, performed at 1, 3, 6, and 12 months postoperatively.nnnRESULTSnThe body mass index loss (BMIL) was 3.9 ± .5 kg/m(2) and 9.4 ± 1.3 kg/m(2) at 1 and 12 months in group 1, respectively. The BMIL was 4.5 ± .9 kg/m(2) and 10.4 ± 1.9 kg/m(2) at 1 and 12 months in group 2, respectively. At 1 and 12 months postoperatively, the percentage of excess body weight loss was 32.2% ± 12.6% and 81.5% ± 20.4% in group 1 and 35.5% ± 10.5% and 83.8% ± 24.5% in group 2, respectively. Except for the BMIL at 1 month after surgery, no significant differences were found in the BMIL or percentage of excess body weight loss.nnnCONCLUSIONnLSG with and without partial enterectomy and omentectomy in our study was an effective method of bariatric surgery, but they did not differ in their effect on weight loss. However, the long-term effect of weight loss with LSG alone or combined with partial enterectomy and omentectomy needs additional study.