Laparoscopic Splenectomy Combined Selective Pericardial Devascularization

Portal hypertension (PH), most often caused by cirrhosis, refers to a series of clinical syndromes characterized by the increased blood pressure of the portal vein system. It is often complicated by splenomegaly and varices. The bleeding of esophageal and gastric varices is the most important cause of death for patients with cirrhosis and portal hypertension, with the death rate of 30–50% [1]. Splenectomy plus pericardial devascularization is used to treat portal hypertension implicated with severe hypersplenism and esophagogastric bleeding varices, with the advantages of safe and effective haemostasis and low long-term recurrence rate [2]. After an in-depth study on the local anatomy of the cardiac region and the gastric coronary vein, Yang Zhen et al. advocated selective pericardial vascular devascularization which maintains the main stem of the coronary vein and the esophageal collateral vein and only removes the perforating vessels outside the serosa of the esophageal and cardiac region, so as to achieve complete devascularization and maintain spontaneous shunt [3].