The standard procedures like full splenectomy or shunt surgery often risk compromising splenic function or leave varices inadequately managed. Against this, a combined technique involving partial splenectomy with pericardial devascularization has been tested as a potential alternative. Between 2016 and 2023, a total of 132 symptomatic patients underwent the procedure.
All the patients successfully underwent surgery without any cases of intraoperative uncontrolled massive bleeding or immediate operative deaths. Blood counts (leukocyte and platelet levels) improved significantly and remained stable from the first year up to 4 years after surgery. This directly addressed hypersplenism, which is a major complication of portal hypertension.
At the 6-month follow-up, over half of the patients (52.27%) showed marked improvement in esophagogastric varices, while 43.18% maintained stable conditions. Only a small minority (4.55%) saw a worsening of their varices. Longer-term follow-ups confirmed that most patients experienced either sustained improvement or stability, with very few showing progression.
Despite the overall success, portal vein thrombosis appeared in about 75% of patients within the first week following surgery. However, this high rate decreased steadily over time as follow-up progressed. Nearly, 13 patients (9.85%) developed necrosis of the splenic remnant, though most remnants remained viable with minimal regrowth.
Serious complications included liver failure in five patients (3.79%), leading to 3 perioperative deaths (2.27%). Postoperative abdominal bleeding occurred in 3 patients, but all were successfully managed with emergency hemostatic surgery.
The findings suggest that partial splenectomy combined with pericardial devascularization provides a crucial balance in effectively managing hypersplenism and varices while preserving functional splenic tissue. Unlike full splenectomy, the technique maintains immune-related benefits of the spleen, which could potentially reduce the infection risks.
Overall, the findings of this study suggests that with careful patient monitoring and postoperative management, partial splenectomy and pericardial devascularization could reshape treatment strategies for this challenging condition.
Source:
Zhang, Y., Wang, S., Yang, J., Bu, J., & Liang, F. (2025). Partial splenectomy and pericardial devascularization for symptomatic patients with portal hypertension: a single-center retrospective study. BMC Surgery, 25(1), 388. https://doi.org/10.1186/s12893-025-03091-5
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