Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

[Instructor] To begin, make an incision on the patient and insert a 10 millimeter trocar and the laparoscope below the umbilicus. Under direct visualization via the laparoscope, place a 12 millimeter trocar in the left and right middle abdomen, respectively. Subsequently, position a five millimeter trocar in the left and right upper abdomen. For splenic artery ligation, use an ultrasonic harmonic scalpel to incise the gastrocolic and gastrosplenic ligaments. Ligate and sever the left gastroepiploic and short gastric vessels. to expose the lesser omental sac and pancreas. Incise the posterior peritoneum at the superior margin of the pancreas. Then dissect and ligate the splenic artery. Perform splenectomy starting from the lower pole of the spleen and sever the splenocolic ligament. Lift the lower pole of the spleen ventrally, and sever the pleural ligament. Next, separate the tail of the pancreas from the splenic pedicle, and sever the splenophrenic ligament near the upper pole of the spleen. Using a linear stapling device with a cartridge, sever the splenic pedicle. For pericardial devascularization, lift and pull the stomach toward the cephalic side. Dissect and expose the left gastric vessels in the back of the stomach. Then ligate and sever the left gastric vessels. Next, dissociate the posterior wall of the stomach toward the cardia. Ligate and sever the posterior gastric vessels. Now pull the stomach toward the lower left, and incise the lesser omentum, along with the anterior serosa of the cardia. Then dissect and expose the branches of the gastric coronary vein, entering the gastric wall. Ligate and sever the gastric branches of the coronary vein. Incise the subphrenic anterior esophageal serosa. Then dissect and dissociate the lower esophagus with a length not less than six centimeters. Afterward, ligate and sever the inferior phrenic vessels and the esophageal branches of the coronary vein. Carefully check for remaining varicose vessels around the cardia before loading the resected spleen into a specimen bag. Finally flush the surgical field using sterile saline. After carefully examining for active bleeding and pancreatic or gastrointestinal collateral injury, place a drainage tube under the left diaphragm. All patients successfully underwent laparoscopic spleen-preserving distal pancreatectomy without conversion to open surgery. The mean operation time was around 215.63 minutes, and the mean intraoperative blood loss was 128.75 milliliters. The mean postoperative drainage time was 5.5 days, and the mean postoperative hospital stay was around 6.5 days. The postoperative complication rate was 25%, with one case each of pulmonary infection and ascites.