In situ subtotal spleen resection combined with selective pericardial devascularization for the treatment of portal hypertension

BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-term effects of subtotal splenectomy and selective pericardial devascularization for PHT remain controversial.AIM To investigate the clinical efficacy and safety of subtotal splenectomy combined with selective pericardial devascularization for the treatment of PHT.METHODS This was a retrospective study of 15 patients with PHT who underwent subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization in the Department of Hepatobiliary Surgery,Qilu Hospital of Shandong University from February 2011 to April 2022.Fifteen propensity score-matched patients with PHT who underwent total splenectomy at the same time served as the control group.The patients were followed for up to 11 years after surgery.We compared the postoperative platelet levels,perioperative splenic vein thrombosis,and serum immunoglobulin levels between the two groups.Abdominal enhanced computed tomography was used to evaluate the blood supply and function of the residual spleen.The operation time,intraoperative blood loss,evacuation time,and hospital stay were compared between the two groups.RESULTS The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower than that in the total splenectomy group(P<0.05),and the postoperative portal system thrombosis rate in the subtotal splenectomy group was also much lower than that in the total splenectomy group.The levels of serum immunoglobulins(IgG,IgA,and IgM)showed no significant differences after surgery compared with before surgery in the subtotal splenectomy group(P>0.05),but serum immunoglobulin IgG and IgM levels decreased dramatically after total splenectomy(P<0.05).The operation time in the subtotal splenectomy group was longer than that in the total splenectomy group(P<0.05),but there were no significant differences in the amount of intraoperative blood loss,evacuation time,or hospital stay between the two groups.CONCLUSION Subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT,not only correcting hypersplenism but also preserving splenic function,especially immunological function.

A Prospective Randomized Trial of Selective versus Nonselective Esophagogastric Devascularization for Portal Hypertension

Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients＇ life. Esophagogastric devascularization（EGDV） has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV（sEGDV） for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group（n=90） or the non-sEGDV（n-sEGDV） group（n=90）. Patients＇ demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference（P〈0.01） in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy（P〉0.05）. It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body＇s voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.

Successful endoscopic treatment of superficial esophageal cancer in a patient with esophageal variceal bleeding:A case report

BACKGROUND The coexistence of esophageal variceal bleeding and superficial esophageal cancer(SEC)is relatively rare in clinical practice.Moreover,there have been few reports of SEC overlying esophageal varices(EVs).Herein,we report our successful use of endoscopic submucosal dissection(ESD),esophageal solitary venous dilatation(ESVD),and endoscopic injection sclerotherapy(EIS)to treat a 75-year-old man who was diagnosed with SEC coexisting with esophageal variceal bleeding.CASE SUMMARY A 75-year-old man was admitted to the hospital due to black stool for 4 days.The patient had a history of liver cancer,cirrhosis,and portal hypertension.Endosco-pic examination revealed esophageal and gastric varicose veins,as well as esoph-ageal carcinoma in situ.We first treated esophageal variceal bleeding by ESVD and EIS.One week later,ESD treatment was done,and the complete rese-ction of early esophageal cancer was successfully completed via endoscopy.There were no postoperative complications,such as bleeding,infection,or perforation.CONCLUSION The sequential treatment of ESVD,EIS,and ESD is an effective method for trea-ting EVs with early esophageal cancer.