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Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage

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Abstract

Background

Intraoperative 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.

Methods

A 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 3.1 ± 0.3 h and the blood loss was 70.5 ± 32.5 ml. The weight of the excised and morcellated spleen was 826.0 ± 155.1 g. The volume of autotransfused blood was 541.0 ± 150.4 ml. No patient received a perioperative allogeneic blood transfusion. There were no significant complications either intraoperatively or postoperatively. The hemoglobin value increased from 9.3 ± 0.8 to 11.5 ± 1.1 g/dl at postoperative day 1 (p < 0.01). During a postoperative follow-up period of 18.0 ± 9.0 months for 18 patients, neither esophageal variceal bleeding nor encephalopathy recurred.

Conclusion

Laparoscopic 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.

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Acknowledgment

Bryan Fandrich from the Permanent Medical Group, Inc., Sacramento, CA, aided in the preparation of the manuscript.

Disclosure

Yuedong Wang, Yun Ji, Yangwen Zhu, Zhijie Xie, and Xiaoli Zhan have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, Zhejiang Provincial People’s Hospital, 158 Shangtang Rd, Hangzhou, 310014, China

    Yuedong Wang, Yun Ji, Yangwen Zhu, Zhijie Xie & Xiaoli Zhan

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  1. Yuedong Wang
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  2. Yun Ji
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  3. Yangwen Zhu
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  4. Zhijie Xie
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  5. Xiaoli Zhan
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Correspondence to Yuedong Wang.

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Wang, Y., Ji, Y., Zhu, Y. et al. Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage. Surg Endosc 26, 2195–2201 (2012). https://doi.org/10.1007/s00464-012-2159-x

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  • DOI: https://doi.org/10.1007/s00464-012-2159-x

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