Robot-assisted partial splenectomy for benign splenic tumors:Four case reports

BACKGROUND Robotic-assisted partial splenectomy(RAPS)is a superior approach for treating splenic cysts and splenic hemangiomas,as it preserves the immune function of the spleen and reduces the risk of overwhelming post splenectomy infection.Curren-tly,there are no standardized guidelines for performing a partial splenectomy.CASE SUMMARY Four patients with splenic cysts or splenic hemangiomas were treated by RAPS.Critical aspects with RAPS include carefully dissecting the splenic pedicle,accurately identifying and ligating the supplying vessels of the targeted segment,and ensuring precise hemostasis during splenic parenchymal transection.Four successful RAPS cases are presented,where the tumors were removed by pret-reating the splenic artery,dissecting and ligating the corresponding segmental vessels of the splenic pedicle,transecting the ischemic segment of the spleen,and using electrocautery for optimal hemostasis.Four patients underwent successful surgeries with minimal bleeding during the procedure,and there were no signs of bleeding or recurrence postoperatively.CONCLUSION Four cases confirm the feasibility and superiority of RAPS for the treatment of benign splenic tumors.

Clinical Outcomes of Complete Mesocolic Excision for Right-Sided Colon Cancer Using 3D Laparoscopy versus 2D Laparoscopy

Objective:To study the clinical outcomes of complete mesocolic excision(CME)for right-sided colon cancer using 3D(three-dimensional)laparoscopy compared to 2D(two-dimensional)laparoscopy.Methods:From January 2022 to December 2023,58 patients with right-sided colon cancer treated at the Affiliated Hospital of Hebei Engineering University were randomly divided into a 3D laparoscopy group(observation group)and a 2D laparoscopy group(control group),with 29 patients in each group.Intraoperative blood loss,postoperative time to first flatulence,length of hospital stay,and incidence of complications in both groups were recorded.Results:There was a statistically significant difference in intraoperative blood loss between the two groups(P<0.05).There was no statistically significant difference in the time to first flatulence between the groups(P>0.05).However,there was a statistically significant difference in the length of hospital stay(P<0.05)and the incidence of complications(P<0.05)between the two groups.Conclusion:3D laparoscopy for CME can reduce intraoperative blood loss,shorten hospital stay,and decrease postoperative complications,showing significant clinical advantages over traditional 2D laparoscopy.

Splenectomy: Indications in the General Surgery Department of Ignace Deen Hospital

Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.

Predictors of portal vein thrombosis after splenectomy in patients with cirrhosis

BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.

Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

BACKGROUND Partial splenic embolization(PSE)has been suggested as an alternative to splenectomy in the treatment of hypersplenism.However,some patients may experience recurrence of hypersplenism after PSE and require splenectomy.Currently,there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.METHODS Between January 2010 and December 2021,321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department.Based on whether PSE was performed prior to splenectomy,the patients were divided into two groups:PSE group(n=40)and non-PSE group(n=281).Patient characteristics,postoperative complications,and follow-up data were compared between groups.Propensity score matching(PSM)was conducted,and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding(IB).The receiver operating characteristic curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA)were employed to evaluate the differentiation,calibration,and clinical performance of the model.RESULTS After PSM,the non-PSE group showed significant reductions in hospital stay,intraoperative blood loss,and operation time(all P=0.00).Multivariate analysis revealed that spleen length,portal vein diameter,splenic vein diameter,and history of PSE were independent predictive factors for IB.A nomogram predictive model of IB was constructed,and DCA demonstrated the clinical utility of this model.Both groups exhibited similar results in terms of overall survival during the follow-up period.CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.

Laparoscopy combined with hysteroscopy in the treatment of Robert’s uterus accompanied by adenomyosis:A case report

BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.

Unexpected right-sided sigmoid colon in laparoscopy: A case report and review of literature

BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.CASE SUMMARY A 71-year-old woman presented with acute appendicitis.A preoperative computed tomography(CT)scan showed peri-appendiceal inflammation but no significant anatomical abnormalities.During laparoscopic surgery,an unexpected finding was encountered:The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon.Postoperative pathological examination confirmed appendicitis with no additional pathological findings.The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging.The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.CONCLUSION This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery,particularly when managing appendicitis.A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development.Awareness of this variation can help prevent surgical complications and inform future clinical practice.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function

BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.

Splenectomy does not affect mouse behaviors

The spleen is critical for immunity.It is the largest immune organ and immune center in the peripheral system.While the relationship between behavior and immunity has been demonstrated in physiology and diseases,the role of the spleen in behavior is not clear.To investigate the effects of the spleen on behaviors,we performed a refined splenectomy procedure on C57BL/6J mice and performed an open field test,circadian rhythm test,elevated plus maze,sucrose preference test,and Barnes maze test.Splenectomy did not induce changes in general locomotion,circadian rhythms,learning and memory,or depression/anxiety-related behaviors.To further investigate the effects of spleen on stress susceptibility,we established mouse models of depression through chronic unpredictable mild stress.The behavioral performances of mice subjected to splenectomy showed no differences from control animals.These findings suggest that splenectomy does not cause changes in baseline behavioral performance in mice.

Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devascularization(SPD)and transjugular intrahepatic portosystemic shunt(TIPS)are effective treatments for EGVB.However,a comparison of the effectiveness and safety of those methods is lacking.AIM To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding(VRB)in patients with HBV-related cirrhosis combined with portal hypertension.METHODS This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013.Propensity score-matched analysis(PSM),the Kaplan-Meier method,and multivariate Cox regression analysis were used to compare overall survival,VRB rate,liver function abnormality rate,and hepatocellular carcinoma(HCC)incidence between the two patient groups.RESULTS The median age was 45.0 years(n=318;226(71.1%)males).During a median follow-up duration of 43.0 mo,18(11.1%)and 33(21.2%)patients died in the SPD and TIPS groups,respectively.After PSM,SPD was significantly associated with better overall survival(OS)(P=0.01),lower rates of abnormal liver function(P<0.001),and a lower incidence of HCC(P=0.02)than TIPS.The VRB rate did not differ significantly between the two groups(P=0.09).CONCLUSION Compared with TIPS,SPD is associated with higher postoperative OS rates,lower rates of abnormal liver function and HCC,and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension.There is no significant between-group difference in VRB rates.

Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy

Because distal pancreatectomy(DP)has no reconstructive steps and less frequent vascular involvement,it is thought to be the easier counterpart of pancreaticoduodenectomy.This procedure has a high surgical risk and the overall incidences of perioperative morbidity(mainly pancreatic fistula),and mortality are still high,in addition to the challenges that accompany delayed access to adjuvant therapies(if any)and prolonged impairment of daily activities.Moreover,surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes.From this perspective,new surgical approaches,and aggressive techniques,such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection,could lead to improved survival in those affected by more locally advanced tumors.Conversely,minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress.The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications,length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy.Because a dedicated multidisciplinary team is crucial to pancreatic surgery,hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign,borderline,and malignant diseases of the pancreas.The purpose of this review is to examine the state of the art in distal pancreatectomies,with a special focus on minimally invasive approaches and oncological-directed techniques.The widespread reproducibility,cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.

Autologous bone marrow infusion via portal vein combined with splenectomy for decompensated liver cirrhosis: A retrospective study

BACKGROUND In a previous study,autologous bone marrow infusion(ABMI)was performed in patients with decompensated liver cirrhosis(DLC)and acquired immunodefi-ciency syndrome and achieved good results,but whether splenectomy affected outcome was unclear.AIM To investigate the efficacy of ABMI combined with splenectomy for treatment of DLC.METHODS Eighty-three patients with DLC were divided into an intervention group(43 cases)and control group(40 cases)according to whether splenectomy was performed.The control group was treated with ABMI through the right omental RESULTS After ABMI,the prothrombin time,serum total bilirubin levels,ascites volume and model for end-stage liver disease score in both groups were significantly lower,while the albumin levels were significantly higher than before ABMI(P<0.01),but there were no significant differences between the groups(P>0.05).After ABMI,the white blood cell and platelets counts in both groups were significantly higher than before ABMI(P<0.01),and the counts in the intervention group were significantly higher than in the control group(P<0.01).After ABMI the CD4+and CD8+T cell counts in both groups were significantly higher than before ABMI(P<0.01).The CD8+T cell counts in the intervention group increased continuously and the increase had a shorter duration compared with control group.CONCLUSION ABMI through the portal vein in patients with DLC can significantly improve liver synthetic and secretory functions,and splenectomy promotes improvement of bone marrow hematopoietic and cellular immune functions.

Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction

BACKGROUND Ileostomies are commonly performed after colon and rectal surgeries.Laparoscopy-assisted ileostomy with adhesion lysis may have potential benefits over conventional open surgery.AIM To compare the outcomes of laparoscopy-assisted and conventional ileostomies.METHODS Data from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively analyzed.The groups comprised 26 and 22 patients who underwent laparoscopic ileostomy(laparoscopic group)and conventional ileostomy(conventional group),respectively,performed by a single surgeon.Patient demographics,operative characteristics,postoperative outcomes,and 30-d morbidities and mortality rates were analyzed.RESULTS The two groups had comparable mean ages,sex distributions,American Society of Anesthesiologists scores,and body mass indices.However,the laparoscopic group showed similar operative time,better visualization for adhesion lysis,and lower visual analog scale scores than the conventional group.CONCLUSION Laparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores,better intraoperative visualization for effective adhesion lysis,and similar operative time compared with conventional ileostomy.

Splenic lymphangioma masquerading as splenic abscess managed by laparoscopic splenectomy: A case report

BACKGROUND Primary benign splenic tumours are unique and account for<0.007%of all tumours identified during surgery and autopsy.Splenic lymphangiomas are rarely seen in adults.Splenic lymphangiomas may be asymptomatic,or may present with upper left abdominal pain,splenomegaly,hypersplenism,or splenic rupture with haemorrhagic shock.The clinical and radiological features of these lesions are not specific.This case report serves to remind the clinician to consider the rare but important differential diagnosis of splenic lymphangioma while treating splenic lesions.CASE SUMMARY We report a case of splenic lymphangioma in a 22-year-old woman who presented with left upper quadrant abdominal pain for three months.Initial investigations were unremarkable;however,computed tomography later revealed multiple splenic micro-abscesses.The patient underwent laparoscopic splenectomy,and histopathological examination revealed splenic lymphangioma.The patient was discharged on postoperative day three.One month after surgery,the abdominal pain resolved completely,with no new complaints.Splenic lymphangiomas present clinically as splenomegaly or left upper quadrant abdominal pain;prompt intervention is necessary for avoiding complications.CONCLUSION This case report concludes that splenic lymphangiomas should be considered in the differential diagnosis of splenomegaly or left upper quadrant pain,even in adults,because they are amenable to curative treatment.Delays in surgical intervention may lead to severe complications,such as infection,rupture,and hemorrhage.Such lesions can be safely managed with laparoscopy,involving less postoperative pain and early patient discharge with excellent cosmetic outcomes.

Systematic review of diagnostic tools for peritoneal metastasis in gastric cancer-staging laparoscopy and its alternatives

BACKGROUND Gastric cancer is one of the leading causes of cancer burden and mortality,often resulting in peritoneal metastasis in advanced stages with negative survival outcomes.Staging laparoscopy has become standard practice for suspected cases before a definitive gastrectomy or palliation.This systematic review aims to compare the efficacy of other diagnostic modalities instead of staging laparoscopy as the alternatives are able to reduce cost and invasive staging procedures.Recently,a radiomic model based on computed tomography and positron emission tomography(PET)has also emerged as another method to predict peritoneal metastasis.AIM To determine if the efficacy of computed tomography,magnetic resonance imaging and PET is comparable with staging laparoscopy.METHODS Articles comparing computed tomography,PET,magnetic resonance imaging,and radiomic models based on computed tomography and PET to staging laparoscopies were filtered out from the Cochrane Library,EMBASE,PubMed,Web of Science,and Reference Citations Analysis(https://www.referencecitationanalysis.com/).In the search for studies comparing computed tomography(CT)to staging laparoscopy,five retrospective studies and three prospective studies were found.Similarly,five retrospective studies and two prospective studies were also included for papers comparing CT to PET scans.Only one retrospective study and one prospective study were found to be suitable for papers comparing CT to magnetic resonance imaging scans.RESULTS Staging laparoscopy outperformed computed tomography in all measured aspects,namely sensitivity,specificity,positive predictive value and negative predictive value.Magnetic resonance imaging and PET produced mixed results,with the former shown to be only marginally better than computed tomography.CT performed slightly better than PET in most measured domains,except in specificity and true negative rates.We speculate that this may be due to the limited F-fluorodeoxyglucose uptake in small peritoneal metastases and in linitis plastica.Radiomic modelling,in its current state,shows promise as an alternative for predicting peritoneal metastases.With further research,deep learning and radiomic modelling can be refined and potentially applied as a preoperative diagnostic tool to reduce the need for invasive staging laparoscopy.CONCLUSION Staging laparoscopy was superior in all measured aspects.However,associated risks and costs must be considered.Refinements in radiomic modelling are necessary to establish it as a reliable screening technique.

Laparoscopic splenectomy:Current concepts

Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes.

Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

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.

Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion

AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.

Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection

AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy or open splenectomy and azygoportal disconnection for portal hypertension.

Laparoscopic versus Open Splenectomy and Devascularization for Massive Splenomegaly Due to Portal Hypertension

Although the clinical benefit of laparoscopic splenectomy and devascularization（LSD） has been elaborated in many studies,its application in massive splenomegaly remains controversial.We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension.Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study,and divided into two groups.Twenty-one patients underwent open splenectomy and devascularization（OSD） from June 2010 to October 2012（OSD group）.From March 2013 to February 2015,LSD was performed on 26 patients（LSD group）.Perioperative variables were analyzed.Compared to OSD,LSD was associated with less blood loss（241.9±110.0 m L vs.319.0±139.5 m L,P〈0.05）,more rapid resumption of oral diet（2.46±0.95 days vs.3.76±1.09 days,P〈0.05）,and shorter postoperative hospital stay（5.35±1.65 days vs.7.24±1.55 days,P〈0.05）.It was concluded that for patients with massive splenomegaly due to portal hypertension,LSD is feasible and as safe as OSD.