Background: This study aimed to evaluate whether laparoscopic splenectomy and azygoportal disconnection (LSD) can promote decompensated cirrhotic portal hypertension (CPH) patients to achieve recompensation as defined by Baveno VII.
Methods: This retrospective study reviewed clinical records and follow-up data of decompensated CPH patients diagnosed with gastroesophageal variceal bleeding (GEVB) and hypersplenism at our hepatobiliary center from 2013 to 2023. According to treatment strategy, patients were categorized into the LSD arm or the endoscopic therapy (ET) arm. Post-treatment liver function, incidence of decompensation events, recompensation, and overall survival were analyzed across the two arms. Furthermore, the mediating effect of LSD on survival through recompensation was analyzed.
Results: This study enrolled 568 eligible patients, with 300 undergoing LSD and 268 receiving ET. Most patients in both groups showed varying degrees of liver function improvement post-treatment. Overall, 307 patients (54.05%) met the Baveno VII criteria for recompensation. More patients achieved recompensation among those treated with LSD as opposed to ET (73.0% VS. 32.8%, OR = 4.569; 95% CI 3.088-6.760; P < 0.001). Mediation assessment indicated that recompensation accounted for 43.3%, 32.4%, and 16.4% of the effect of LSD on mortality at 3, 5, and 8 years, respectively. Furthermore, younger patients were more likely to achieve recompensation after LSD.
Conclusions: LSD was found to significantly promote recompensation and extend survival in decompensated cirrhosis patients with CPH bleeding and hypersplenism.
Keywords: Decompensated cirrhosis; Laparoscopic splenectomy and azygoportal disconnection; Recompensation; Transplant-free survival time.
© 2025. The Author(s), under exclusive licence to Japanese Society of Gastroenterology.