Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18420
Revised: October 23, 2014
Accepted: December 1, 2014
Published online: December 28, 2014
AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.
METHODS: We retrospectively evaluated outcomes in 79 patients admitted to the Clinical Medical College of Yangzhou University with cirrhosis, portal hypertensive bleeding and secondary hypersplenism who underwent MLSD without (n = 46) or with intraoperative cell salvage and autologous blood transfusion, including splenic blood and operative hemorrhage (n = 33), between February 2012 and January 2014. Their intraoperative and postoperative variables were compared. These variables mainly included: operation time; estimated intraoperative blood loss; volume of allogeneic blood transfused; visual analog scale for pain on the first postoperative day; time to first oral intake; initial passage of flatus and off-bed activity; perioperative hemoglobin (Hb) concentration; and red blood cell concentration.
RESULTS: There were no significant differences between the groups in terms of duration of surgery, estimated intraoperative blood loss and overall perioperative complication rate. In those receiving salvaged autologous blood, Hb concentration increased by an average of 11.2 ± 4.8 g/L (P < 0.05) from preoperative levels by the first postoperative day, but it had fallen by 9.8 ± 6.45 g/L (P < 0.05) in the group in which cell salvage was not used. Preoperative Hb was similar in the two groups (P > 0.05), but Hb on the first postoperative day was significantly higher in the autologous blood transfusion group (118.5 ± 15.8 g/L vs 102.7 ± 15.6 g/L, P < 0.05). The autologous blood transfusion group experienced significantly fewer postoperative days of temperature > 38.0 °C (P < 0.05).
CONCLUSION: Intraoperative cell salvage during MLSD is feasible and safe and may become the gold standard for liver cirrhosis with portal hypertensive bleeding and hypersplenism.
Core tip: Because of the impairment of hepatic synthetic function and intractable coagulopathy, one of the most serious complications during laparoscopic splenectomy and azygoportal disconnection (LSD) is rapid loss of large volumes of blood. Intraoperative cell salvage and autologous blood transfusion of splenic blood and operative hemorrhage during LSD can increase hemoglobin concentration and reduce or obviate the need for intraoperative allogeneic transfusion. An autologous blood salvage device can minimize intraoperative blood loss and make full use of the large red cell pool sequestered in an enlarged spleen. At the same time, it will encourage more surgeons to perform LSD.