The therapeutic effect of splenectomy plus selective pericardial devascularization versus conventional pericardial devascularization on portal hypertension in China: A meta-analysis

Abstract

Background: To systematically review perioperative outcomes and postoperative complications between splenectomy plus s-EGDV and n-sEGDV for portal hypertension complicated with thoracic esophageal varices and bleeding by a meta-analysis. Method: We searched the databases of PubMed, the Cochrane Library, Web of Science, EMBASE, TCGA, Chinese Biomedicine Database from January 2000 to June 2017, and included studies that compared perioperative outcomes and postoperative complications between s-EGDV and n-sEGDV. These included studies were assessed by two independent investigators. Results: Seven randomized controlled trials (RCTs) and seven non-randomized observational clinical studies (OCS) were included. The s-EGDV was more beneficial than n-sEGDV in reducing the PVF (OR = 4.26; 95% CI, 2.81-5.71; P < 0.00001; I2 = 97% for heterogeneity), portal vein flow (OR = -111.75; 95% CI, -197.13-26.38; P = 0.01; I2 = 90% for heterogeneity), portal hypertensive gastropathy(OR = 0.38; 95% CI, 0.28-0.51; P < 0.00001; I2 = 0% for heterogeneity), hepatic encephalopathy (OR = 0.40; 95% CI, 0.23-0.71; P = 0.002; I2 = 22% for heterogeneity), postoperative re-bleeding (OR = 0.43; 95% CI, 0.29-0.63; P < 0.0001; I2 = 9% for heterogeneity), postoperative mortality (OR = 0.52; 95% CI, 0.32-0.85; P = 0.009; I2 = 0% for heterogeneity) and in increasing hepatic artery flow (OR = 92.53; 95% CI, 9.60- 175.46; P = 0.03; I2 = 95% for heterogeneity). Conclusion: sEGDV offers a more effective surgical approach with fewer complications to treat portal hypertension than n-sEGDV. Upon further detailed analysis of the surgical indications and hemodynamic and postoperative major complications of selective devascularization, sEGDV likely will provide us with a new direction in the choice of surgical approach for portal hypertension.