Comparative observation of laparoscopic and laparotomy surgery in the treatment of portal hypertension
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Abstract:
Objective
To observe and to compare the efficacy of laparoscopic and laparotomy splenectomy and pericardial devascularization in the treatment of portal hypertension.
Methods
From March 2013 to December 2018, clinical data of patients with portal hypertension for splenomegaly, hypersplenism and esophageal and gastric fundus varices were analyzed retrospectively, among them, 21 cases underwent laparoscopic splenectomy and pericardial devascularization (laparoscopic group) and 50 cases underwent laparotomy of splenectomy and pericardial devascularization (laparotomy group). Statistical analysis were performed by using GraphPad Prism 6.0 software. Measurement data such as intraoperative and postoperative indicators were expressed as (±s) and examined by using independent t-test. The complication rate were compared by using χ2 test. Survival were analyzed by using Kaplan Meier method, and were examined by using log rank test. A P value of <0.05 was considered as statistically significant difference.
Results
Compared with laparotomy group, in addition to much longer operating time(P 0.05).
Conclusion
Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension has the advantages of less surgical trauma, less intraoperative bleeding, faster postoperative recovery, lower incidence of postoperative incision infection, and shorter hospital stay. Laparoscopic surgery for the treatment of portal hypertension is safe and feasible.
Key words:
Hypertension, portal; Splenectomy; Laparoscopes; Laparotomy; Comparative effectiveness researchObjective: To evaluate the efficacy and safety of laparoscopic and open splenectomy and esophagogastric devascularization for portal hypertension by means of systematic review.Methods: The literature of studies related to laparoscopic versus open splenectomy and esophagogastric devascularization was collected by searching the national and international online databases.he articles were screened according to the inclusion and exclusion criteria.Ater data extraction and quality assessment,Meta-analysis was performed by using RevMan 5.2 sotware.Results: No randomized controlled trial was found in the literature,and 11 non-randomized controlled clinical trials were inally included,with a total of 494 patients,of whom,227 cases underwent laparoscopic surgery(laparoscopic group) and 267 cases were subjected to open surgery(laparotomy group).Compared with laparotomy group,the results of Meta–analysis showed that in laparotomy group,the operative time was prolonged,and the intraoperative blood loss,surgical complications and length of postoperative hospital stay was reduced,but the hospitalization costs were increased.All the diferences reached statistical signiicance(all P0.05).Conclusion: Compared with open surgery,laparoscopic splenectomy and esophagogastric devascularization has the advantages of reduced intraoperative blood loss,postoperative hospital stay and complications,but it has increased hospitalization costs and operative time.However,this conclusion should be considered cautiously,due to limitations in the quality and quantity of the included studies.
Open surgery
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Objective To discusses the clinical curative effect of patients with acute cholecystitis laparotomy and laparoscopic surgery application. Methods 80 cases of patients with acute cholecystitis were randomly divided into laparotomy group and laparoscopic group,40 cases in each group.Patients were given laparotomy and laparoscopic surgery treatment,compared clinical therapeutic effect of two groups after treatment. Results Two groups of patients with intraoperative time had no statistical difference(P 0.05).Laparoscopic group of patients with intraoperative haemorrhage,postoperative exhaust time,postoperative ambulation time,led traffic and length of hospital stay were significantly lower than laparotomy group(P0.05).Compare two groups of patients with surgery related complications is also statistically significant,the laparoscopic group is superior to laparotomy group(P 0.05). Conclusion In patients with acute cholecystitis can significantly improve the clinical application effect by laparoscopic surgery treatment,also can reduce the incidence rate of complications related to the operation at the same time.
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Objective
To investigate the application value of laparoscopic splenectomy combined with endoscopic variceal ligation in cirrhosis and portal hypertension.
Methods
Sixty-three patients with cirrhosis and portal hypertension undergoing laparoscopic splenectomy combined with endoscopic variceal ligation in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between September 2011 and September 2014 were included in the prospective study. The patients were randomized into the laparoscopy group and the laparotomy group according to different surgical procedures. Among the 28 patients in the laparoscopy group, 25 were males and 3 were females with the age ranging from 40 to 69 years old and the median of 55 years old. Among the 35 patients in the laparotomy group, 32 were males and 3 were females with the age ranging from 43 to 69 years old and the median of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients of two groups underwent endoscopic variceal ligation during the splenectomy. The duration of operation, intraoperative blood loss, length of hospital stay, treatment costs and incidence of postoperative complications of two groups were observed. The comparison of the observed indexes of two groups was conducted using t test and the rate comparison was conducted using Fisher's exact test.
Results
All the patients completed the surgery successfully. The duration of operation and the intraoperative blood loss were (113±8) min and (204±52) ml for the laparoscopy group, and were (106±6) min and (226±63) ml for the laparotomy group where no significant difference was observed (t=1.97, -0.75; P>0.05). The length of hospital stay and treatment costs of laparoscopy group were (6.0±1.2) and (35 000±3 000) RMB, which were significantly lower than (11.2±2.7) and (45 000±1 000) RMB of laparotomy group (t=-4.87, -6.81; P<0.05). Eight patients in the laparoscopy group developed complications, among them, 7 were with portal venous thrombosis and 1 was with recurrent hemorrhage. Seventeen patients in the laparotomy group developed complications, among them, 10 were with portal venous thrombosis and 7 were with fat liquefaction of incisions. The incidence of fat liquefaction of incisions in laparoscopy group was significantly lower than that of the laparotomy group (P=0.035).
Conclusion
Laparoscopic splenectomy combined with endoscopic variceal ligation can achieve the similar curative effect with laparotomy and has the advantages of small operational wound, quick recovery, less complications, as well as shorter length of hospital stay and lower total treatment costs.
Key words:
Laparoscopes; Splenectomy; Natural orifice endoscopic surgery; Liver cirrhosis; Hypertension, portal
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Objective To explore the feasibility and short-term clinical efficacy of laparoscopic resection for rectal cancer.Methods Retrospective study was done on 50 cases of laparoscopic and 41 cases of conventional laparotomy from August 2008~January 2010,we compared the postoperative situation between two groups.Results Operative time of Laparoscopic group was longer than the laparotomy group,blood loss was less than open surgery group,recovery time of post-operative intestinal function earlier than that of laparotomy group,postoperative hospital stay (including a ride after chemotherapy) shorter than in laparotomy group.The above differences were statistically significant.The number of lymph node dissection has no difference statistically.In Laparoscopic group,8 cases were with complications,1 case was with peritoneal metastasis and local recurrence,while 15 cases and 2 cases in laparotomy group,respectively.Two groups had no tumor growing and the recent cut deaths.Conclusion The method of laparoscopic colorectal surgery is safe and effective,with less bleeding and trauma,the advantages of rapid recovery can be achieved to be the same as the open surgery.
Open surgery
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Objective To explore the feasibility and effect of laparoscopic splenectomy (LS). Methods The clinical data of 33 cases underwent laparoscopic splenectomy were analyzed retrospectively. Results Thirty-three cases were successfully performed by laparoscopic splenectomy. The average operative time was 150 min and blood loss was 125 ml. The average spleen weight was 665 g. The postoperative hospitalization was 8 d. There were no operative complications. Postoperative platelet count averagely from preoperative 42×109/L rose to 189×109/L. Conclusion Laparoscopic splenectomy is a kind of safe,effective and minimal wound surgery.
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Objective: To compare the clinical efficacy of the hand-assisted laparoscopic and open splenectomy and pericardial devascularization. Methods: Thirty patients were randomly assigned to laparoscopic group and laparotomy group,laparotomy group underwent traditional open splenectomy,laparoscopic group underwent hand-assisted laparoscopic pericardial devascularization. Results:Hospital stay and postoperative anal exhaust time of laparoscopic group were shorter than those of the laparotomy group,and there was less blood loss in the laparoscopic group,but the operation time was longer than the laparotomy group( P 0. 05). Complication rate of laparotomy group was 26. 7%( 4 /15). Two patients in laparoscopic group suffered from serious postoperative complications,the postoperative complication rate was 13. 3%( 2 /15). The incidence of complications was lower than laparotomy group,the difference was statistically significant(χ2= 4. 156,P 0. 05). Conclusions: Hand-assisted laparoscopic splenectomy plus pericardial devascularization increases the safety of surgery,while reduces the incidence of complications,and its recent results are satisfactory,safe and feasible,with the advantages of minimally invasive surgery and broad application prospects.
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Objective: To investigate the clinical efficacy of hand-assisted laparoscopic splenectomy combined with portal-azygous devascularization for portal hypertension,in order to provide the basis for its clinical application. Methods: Fifty-two patients who suffered from portal hypertension were included in this study. All patients were performed splenectomy combined with portal-azygous devascularization. Patients were randomly divided into observation group and control group by random number method. 26 cases in observation group were given hand-assisted laparoscopy,26 cases in control group were given open procedure. The intraoperative bleeding,operative time and hospital stay were observed. The influences on stress responses( plasma levels of TNF-α,IL-6 and CRP) were measured after surgery and comparatively analyzed. Results: The observation group showed significantly less intraoperative blood loss,shorter operation time,earlier anus exhaust,shorter hospital stay,fewer volume and shorter time of postoperative drainage,the differences were statistically significant( P 0. 05). The maximum diameter of spleen in control group was greater than that in observation group,but the difference was not statistically significant( P 0. 05). The value of laboratory test of observation group was significantly less than that of control group in such indexes as plasma levels of TNF-α,IL-6 and CRP after operation,the difference was statistically significant( P 0. 05). Conclusions: Hand-assisted laparoscopic splenectomy combined with portal-azygous devascularization for portal hypertension has a better clinical effect. It can reduce the intraoperative blood loss,postoperative drainage,operative time and hospital stay. The body's stress response is also lower.
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Objective To explore the clinical application of laparoscopic splenectomy in treatment of spleen disease at our hospital.Methods We reviewed laparoscopic splenectomy carried out at our hospital since 1995,patients were grouped by date.63 laparoscopic splenectomies were divided into six groups.Operation time,intraoperative blood loss,postoperative hospital stay,time to feeding,days of drainage,amount of drainage,postoperative complications and indications for surgery were compared.Results Patient's age averaged at 44.19 years,body mass index averaged at 23.75,3 patients were converted to open surgery.Mean operating time,blood loss,postoperative hospital stay,time to feeding,converting rate in the 53 cases which had the surgery after 2003 were much better than the 10 cases before 2003.Surgical indications for laparoscopic splenectomy were limited to hematopoietic disease related splemegaly before 2003,the indication range significantly expanded after 2003,during which laparoscopic splenectomy were mainly applied to treat spleen tumors.Conclusions There is a marked learning curve in laparoscopic splenectomy after 10 surgeries before 2003 we have achieved the level.With the suitable approach,apparatus and skillful technique,laparoscopic splenectomy is safe and feasible to treat tumors of the spleen.
Key words:
Splenic neoplasms ; Hematologic diseases ; Laparoscopy ; Splenectomy
Hematologic disease
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Objective: To investigate the surgical skills of laparoscopic splenectomy(LS).Methods:The clinical data of 25 cases undergoing LS were retrospectively analyzed.Results:All operations were successful and no conversion to open surgery occurred.Five patients with hypersplenism underwent hand-assisted laparoscopic splenectomy(HALS),and the other 20 patients underwent complete LS.The operating time was 80~400(152±34)min and the intraoperative blood loss was 20~2000(290±171)mL.The postoperative hospital stay was 2~21 days(mean:7.5 days).Postoperative complication occurred in 3 cases(12.0%,3/25),including one subcutaneous emphysema and one left lateral abdominal wall diffuse ecchymosis and one splenic fever.The total therapeutic response rate of ITP was 86.7%(13/15).Conclusions:LS is safe and feasible for splenectomy,and HALS technique could be considered for hypersplenism.
Ecchymosis
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Objective To explore the feasibility and advantage of hand-assisted laparoscopic splenectomy plus porta-agygous devascularization.Methods Fifty-eight patients with hepatocirrhosis and portal hypertension underwent either hand-assisted laparoscopic splenectomy plus porta-agygous devascularization(29 patients) or open splenectomy(29 patients).Parameters,including operating time,blood loss,duration of fever,postoperative exhaust time,duration of postoperative pain,length of postoperative hospital stay,wound infection rate,recurrence of hemorrhage and rise in total bilirubin were measured.Results Hand-assisted laparoscopic splenectomy plus porta-agygous devascularization was successful in all 29 patients.Compared with open surgery,hand-assisted laparoscopic splenectomy plus porta-agygous devascularization decreased operation time,blood loss,duration of fever,duration of postoperative pain,length of postoperative hospital stay and wound infection rate,and accelerated postoperative exsufflation(P0.05).There were no significances in hemorrhage recurrence and bilirubin rise between the two procedures 1 year after operation(P0.05).Conclusion Hand-assisted laparoscopic splenectomy plus porta-agygous devascularization is feasible and safe in patients with hepatocirrhosis and portal hypertension,and offers advantages over open surgery.
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