Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5794
Revised: January 13, 2014
Accepted: March 8, 2014
Published online: May 21, 2014
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.
Core tip: With meticulous surgical techniques and advanced instruments, laparoscopic splenectomy is becoming a technically feasible, safe, and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension, and contributes to decreased blood loss, a 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 LigaSure vessel sealing equipment, and blunt dissection be avoided. Use of the vascular stapler is reported to shorten and facilitate hilar dissection compared with the former techniques of ligation or clipping.