Laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices with hypersplenism

Background: The combination of sclerotherapy with surgical salvage for sclerotherapy-resistant esophagogastric varices has recently received much attention, however, the longterm results after such an operation have yet to be reported. This is a preliminary report of a laparoscopic adaptation of a previously described surgical procedure for the treatment of refractory esophagogastric varices. Study Design: Laparoscopic gastric devascularization and splenectomy (Hassab's operation) was successfully performed to treat recurrent sclerotherapy-resistant giant esophageal varices (n = 4) and recurrent rebleeding gastric varices (n = 6). The patients included 8 men and 2 women who ranged in age from 35 to 67 years (average, 54.2 years). The procedure and clinical results were evaluated from various viewpoints. Results: The duration of the operation ranged from 200 to 400 minutes (mean +/- standard deviation; 287.5 +/- 66.0 minutes) and blood loss from 10 to 1,500 mt (average, 515.5 +/- 507.9 mL). The weight of the spleen ranged from 500 to 850 g (average 608.0 +/- 126.6 g). Conversion to minimal open operation with a gasless lifting method was done in 1 patient because of uncontrolled bleeding from the splenic vein. There were no other major complications either intraoperatively or postoperatively, All patients had hypersplenism; preoperative platelet counts ranged from 1.6 to 6.8 x 10(4)/mu L (average, 4.5 +/- 2.7 x 10(4) mu L) and the postoperative count was from 5.9 to 36.0 x 10(4)/mu L (average, 21.7 +/- 11.5 x 10(4) mu L). Postoperative endoscopy revealed that varices disappeared, and no patient had recurrence of the varices after operation during the mean followup period of 12.8 +/- 4.1 months (average, 8 to 20 months). Conclusions: The combination of laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices is considered a feasible and relatively safe surgical method for patients with hypersplenism. (J Am Coll Surg 1998;187:263-270. (C) 1998 by the American College of Surgeons)