Abstract: Objective:To explore the clinical efficacy of the gap above the splenic pedicle in laparoscopic splenectomy (LS).
Methods:The retrospective cohort study was conducted. The clinical data of 189 patients who underwent LS in the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between August 2012 and March 2015 were collected. Among 189 patients receiving splenic pedicle division, 42 without the application of the gap above the splenic pedicle were allocated into the group A and 147 with the application of the gap above the splenic pedicle were allocated into the group B. Observation indicators included: (1) operation situations: combined operation, operation time (excluding combined operation time),volume of intraoperative blood loss (excluding blood volume of spleen), cases with conversion to open surgery; (2) postoperative situations: time to initial anal exsufflation, time for fluid diet intake, occurrence of postoperative complications and duration of hospital stay; (3) followup. Patients were followed up by telephone interview and outpatient examination up to August 2016. Followup included routine blood test, coagulation function, liver function, with or without longterm complications. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Comparisons of count data were analyzed by the chisquare test.
Results:(1) Operation situations: of 189 patients undergoing LS, 136 combined with laparoscopic pericardial devascularization, 13 combined with laparoscopic cholecystectomy, 9 combined with laparoscopic radio frequency ablation (RFA) of liver tumors and 26 combined with pathological examination using laparoscopic liver tissues sampling. Operation time, volume of intraoperative blood loss and cases with conversion to open surgery were (118±31)minutes, (80±38)mL, 2 in the group A and (70±22)minutes, (50±28)mL, 1 in the group B, respectively, with statistically significant differences between the 2 groups (t=12.579,-8.516,x²=4.912, P<0.05). (2) Postoperative situations: time to initial anal exsufflation, time for fluid diet intake, number of patients with postoperative complications and duration of hospital stay were (22±10)hours, (3.1±1.3)days, 8, (9±3)days in the group A and (23±11)hours, (3.8±1.8)days, 13, (8±3)days in the group B, respectively. Pancreatic fistula, intraabdominal hemorrhage, asymptomatic portal vein thrombosis, pulmonary infection and intraperitoneal infection were respectively detected in 2, 2, 2, 1, 1 patients in the group A and 1, 2, 5, 2, 3 patients in the group B. There was no significant difference in time to initial anal exsufflation, time for fluid diet intake and duration of hospital stay between the 2 groups (t=1.102, 0.745, 0.583, P>0.05), and a statistically significant difference in number of patients with postoperative complications between the 2 groups (x²=7.259, P<0.05). There were statistically significant differences in cases with pancreatic fistula and intraabdominal hemorrhage (x²=16.021, 5.812, P<0.05) and no significant difference in cases with asymptomatic portal vein thrombosis, pulmonary infection and intraperitoneal infection (x²=1.391, 0.396, 0.865, P>0.05). Patients with postoperative complications were cured by symptomatic treatment. (3) Followup: 156 of 189 patients (33 in the group A and 123 in the group B) were followed up for 1-18 months, with an average time of 12 months. During the followup, 13 patients had recurrent hematemesis and melena, including 3 in the group A and 10 in the group B. Eight patients stopped bleeding after conservative treatment, 3 stopped bleeding after proxial gastrectomy and 2 died of excessive bleeding and organ failure.
Conclusion:Splenic pedicle division using EndoGIA through the gap above the splenic pedicle in LS can reduce operation time, volume of intraoperative blood loss, rate of conversion to open surgery and postoperative complications.