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Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism

  • Topics
  • Evolution and challenge in endoscopic HBP surgery
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/purpose

The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension.

Methods

From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (≧1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed.

Results

There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively.

Conclusions

With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hirofumi Kawanaka, Tomohiko Akahoshi, Nao Kinjo, Kozou Konishi, Daisuke Yoshida, Go Anegawa, Shohei Yamaguchi, Hideo Uehara, Naotaka Hashimoto, Norifumi Tsutsumi, Morimasa Tomikawa & Yoshihiko Maehara

  2. Department of Surgery, Fukuoka City Hospital, 13-1 Yoshizuka-honmachi, Hakata-ku, Fukuoka, 812-8582, Japan

    Hirofumi Kawanaka, Kenichi Koushi, Noboru Harada, Yasuharu Ikeda, Daisuke Korenaga & Kenji Takenaka

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  1. Hirofumi Kawanaka
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  2. Tomohiko Akahoshi
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Corresponding author

Correspondence to Hirofumi Kawanaka.

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Cite this article

Kawanaka, H., Akahoshi, T., Kinjo, N. et al. Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism. J Hepatobiliary Pancreat Surg 16, 749–757 (2009). https://doi.org/10.1007/s00534-009-0149-8

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  • DOI: https://doi.org/10.1007/s00534-009-0149-8

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