To evaluate the safety and efficacy of five-step laparoscopic splenectomy (LS) with splenic artery ligation first for massive splenomegaly secondary to portal hypertension and liver cirrhosis.

Clinical data of 11 patients with portal hypertensive splenomegaly undergoing LS with splenic artery ligation first in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University from September 2017 to September 2019 were retrospectively analyzed. Among them, 8 patients were male and 3 female, aged (41±10) years on average. The length of spleen was measured ≥20 cm. All patients underwent five-step LS with splenic artery ligation first. The splenic pedicle was totally dissected through the space between the upper margins of splenic pedicle. After the splenic pedicle was severed, the short gastric vessels at the upper pole of spleen were treated. Perioperative conditions of the patients were observed.

All patients successfully completed the five-step LS with splenic artery ligation first, and no patients were converted to open surgery during operation. The operation time was (275±47) min, intraoperative blood loss was (315±85) ml, postoperative food intake time was (2.9±1.4) d, and postoperative length of hospital stay was (11±4) d. No perioperative death, postoperative fever, pleural effusion or other complications occurred.

For patients with liver cirrhosis and portal hypertensive splenomegaly, five-step LS with splenic artery ligation first is a convenient, safe and efficacious operation, which optimizes the procedures of splenectomy.