First, what is portal hypertension As the name suggests, portal hypertension is a series of symptoms such as elevated pressure in the portal venous system caused by various reasons, splenomegaly, rupture and bleeding of esophageal varices, and so on. The human body has two sets of vascular systems. One set is the blood flow system that emanates from the heart and nourishes the limbs and organs throughout the body. The portal vein system is the vascular system in which blood flows to the liver for further processing of nutrients after the body absorbs nutrients from the intestines. Both blood flow systems go to the liver. Because of the relatively low pressure of blood flow in the portal vein system, when the liver hardens and the resistance within the liver increases, the resistance of portal vein blood flow into the liver increases, causing splenomegaly and esophageal varices. As the spleen enlarges, the destruction of blood cells is enhanced, and this causes a decrease in white blood cells and platelets, which is known as hypersplenism. There are more traffic branches between the portal vein and the vena cava. In the case of portal hypertension, in order to return the blood stagnated in the portal venous system, these traffic branches are opened in large numbers, and the collateral circulation is established, whose main collateral circulation is the traffic vessel between the lower esophagus and the inferior vena cava. Once this traffic vessel ruptures, it can cause fatal hemorrhage. There are many causes of portal hypertension. The most common is cirrhosis due to chronic hepatitis. Other less common causes include cirrhosis caused by schistosomiasis and elevated pressure in the portal vein system caused by vascular obstruction. Second, what are the dangers of portal hypertension Because portal hypertension mostly develops from chronic hepatitis and cirrhosis, many people have a history of hepatitis, have been hospitalized for hepatitis, and some people don’t even know they have hepatitis. The spleen is not palpable under normal conditions. When the spleen is enlarged, it can be palpated under the left costal margin to varying degrees, with the larger ones reaching below the umbilicus. Giant splenomegaly is particularly common in schistosomiasis cirrhosis. In the early stage, the enlarged spleen is soft and mobile; in the late stage, it becomes hard due to the proliferation of fibrous tissue within the spleen, and its mobility is reduced by peri-splenic adhesions. The splenomegaly is accompanied by varying degrees of hypersplenism, as evidenced by a decrease in white blood cell count to less than 3×109/L, a decrease in platelet count to less than (70-80)X 109/L, and a gradual tendency to hemorrhage. Acute, unstoppable upper gastrointestinal hemorrhage can be caused by rupture of varicose veins in the submucosa of the lower esophagus and fundus of the stomach. Bright red blood may be vomited in jets. After the bleeding is treated with stomach acid and other digestive juices, it is excreted in the feces as black, tarry stools. The main reasons why bleeding is difficult to stop by itself are: 1) poor liver function, poor coagulation function; 2) hypersplenism, thrombocytopenia, so that the coagulation function is impaired; 3) high pressure in the portal vein, so that the blood vessels can not contract by themselves to stop bleeding. Hemorrhage can cause severe hypoxia of liver tissue, easily leading to hepatic coma, which is the most dangerous complication of portal hypertension. Third, how to know got portal hypertension 1, when ever had a history of hepatitis, or chronic liver disease patients (some people may not know they have hepatitis) appeared splenomegaly, varicose veins in the lower esophagus (or appear vomiting blood, black stool) and ascites, that is portal hypertension. 2.Due to the enlarged spleen, patients with portal hypertension are often accompanied by a significant decrease in white blood cells and platelets, which is called hypersplenism. 3.Sub-esophageal varices can be determined by gastroscopy or barium esophageal examination. When patients have the above manifestations, they should go to the hospital in time. 4.It is not difficult to arrive at a correct diagnosis through detailed inquiry of medical history, comprehensive physical examination and laboratory tests. 5.Abdominal ultrasound and CT examination can reveal splenomegaly and widening of the main trunk of the portal vein. 6.Gastroscopy and upper gastrointestinal barium meal examination can find varicose veins at the lower end of the esophagus. Minimally invasive treatment of portal hypertension The biggest threat of portal hypertension in liver cirrhosis is upper gastrointestinal bleeding caused by rupture of esophageal varices, which is often ferocious and fatal if not treated in time. Surgical treatment of this disease is aimed primarily at ruptured esophageal variceal bleeding. At the same time, the removal of the huge spleen reduces the blood flow to the portal vein system, which can further reduce the pressure on the portal vein system. The problem of hypersplenism (decreased white blood cells and platelets) caused by the huge spleen is also addressed at the same time. Splenectomy and periportal vascular dissection are major operations in hepatobiliary surgery. They often require very long incisions, heavy bleeding, patients are usually in pain, and have a long hospital stay. Minimally invasive surgery, i.e., total laparoscopic splenectomy combined with peripancreatic vascular dissection has the advantages of shorter operation time, less intraoperative bleeding, lower incidence of postoperative complications, quicker recovery of gastrointestinal function and shorter hospitalization time, compared with traditional open surgery. As one of the earliest clinical departments in the city to carry out laparoscopic technology, the Department of Hepatobiliary Surgery of our hospital has accumulated rich experience in minimally invasive laparoscopic treatment, especially in laparoscopic organ resection with unique advantages.