Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection

Objective To investigate the clinical safety and value of vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection. Methods A total of 60 cirrhotic patients with bleeding portal hypertension undergoing modified laparoscopic splenectomy and azygoportal disconnection between Apr 2015 and Sep 2016 were retrospectively analyzed. Patients were divided into non-vagus nerve-preserving (n=37) and vagus nerve-preserving group (n=23). Results Operative time (169±42) min, and incidences of postoperative complications (102/370), delayed gastric emptying (35/37), epigastric fullness (22/37), diarrhea (26/37) in non-vagus nerve-preserving group were all more than those in vagus nerve-preserving group [(147±21)min, (21/230), (2/23), (2/23), (2/23)](t=2.684, χ2=29.583, 44.272, 15.229, 21.606, all P<0.05). There was no significant between-group difference in body weight at admission and on postoperative day 7 (POD 7) between the two groups. However, body weight in vagus nerve-preserving group was significantly higher on postoperative 6 month (POM) compared with that in non-vagus nerve-preserving group [(63±10) kg vs. (70±12) kg, t=2.546, P<0.05]. There was no significant between-group difference in ALB levels at admission and on POD 7 between the two groups. However, ALB levels in vagus nerve-preserving group at POM 6 were significantly higher than those in non-vagus nerve-preserving group [(42±6) g/L vs. (46±5) g/L, t=-2.607, P<0.05]. Conclusion Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection for cirrhotic portal hypertension is safe, feasible and with good therapeutic effect. Key words: Hypertension, portal; Vagus nerve; Laparoscopy; Azygoportal disconnection