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World Journal of Surgery
Published in: World Journal of Surgery 3/2007

01-03-2007

Significance of Laparoscopic Splenectomy in Patients with Hypersplenism

Authors: Yuji Watanabe, MD, PhD, Atsushi Horiuchi, MD, PhD, Motohira Yoshida, MD, Yuji Yamamoto, MD, Hiroki Sugishita, MD, Teru Kumagi, MD, PhD, Yoichi Hiasa, MD, PhD, Kanji Kawachi, MD, PhD

Published in: World Journal of Surgery | Issue 3/2007

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Abstract

Objective

This study was aimed at investigating the efficacy and safety of minimally invasive laparoscopic splenectomy in patients with hypersplenism secondary to cirrhosis.

Background

While advances have been made in the treatment of liver cancer and chronic hepatitis, certain treatments such as radio frequency ablation (RFA) must often be discontinued due to thrombocytopenia caused by hypersplenism. Laparoscopic splenectomy is performed to treat diseases as idiopathic thrombocytopenic purpura, but is contraindicated for hypersplenism in many institutions. Few studies have thus examined the safety and efficacy of this approach.

Methods

Efficacy and safety were retrospectively analyzed for laparoscopic splenectomies starting from January 2003. Relationships between postoperative increases in platelet count and thrombopoietin, platelet-associated immunoglobulin, excised spleen weight, and serum parameters were examined. Perioperative data of open splenectomies starting from January 1990 were compared with those of laparoscopic splenectomies.

Results

No laparoscopic cases were converted to open surgery in this series. Mean operative times of open and laparoscopic splenectomy were 205 and 173 min respectively. Mean blood losses were 750 and 359 ml (P < 0.05) and the mean weights of excised spleen were 460 and 525 g respectively. Postoperatively, no changes in liver function were noted, and platelet and leukocyte counts were significantly increased. Compared with preoperative platelet count, degree of increase at 2 weeks postoperatively did not correlate with preoperative thrombopoietin levels, but significantly correlated with levels of platelet-associated immunoglobulin and spleen volume (P < 0.05). Postoperative portal or splenic vein thrombosis (PSVT) was seen in 3 patients and these patients did not exhibit any clinical symptoms.

Conclusions

Laparoscopic splenectomy is a safe technique for the treatment of hypersplenism and contributes to postoperative increases in platelet counts. Postoperative increases in platelet count seem to depend on platelet-associated immunoglobulin level and spleen weight, which may be valuable prognosticators.
Literature
1.
Mach J, Bueno RS, Wong LL. Long-term follow-up outcome of patients undergoing radiofrequency ablation for unresectable hepatocellular carcinoma. World J Surg 2005;29:1364–1373CrossRef
2.
Akamatsu M, Yoshida H, Obi S, et al. Evaluation of transcatheter arterial embolization prior to percutaneous tumor ablation in patients with hepatocellular carcinoma: a randomized controlled trial. Liver Int 2004;24:625–629PubMedCrossRef
3.
Sakaguchi Y, Kudo M, Fukunaga T, et al. Low-dose, long-term, intermittent interferon-alpha-2b therapy after radical treatment by radiofrequency ablation delays clinical recurrence in patients with hepatitis C virus-related hepatocellular carcinoma. Intervirology 2005;48:64–70PubMedCrossRef
4.
Hosogi H, Ikai I, Hatano E, et al. Complete response by a combination of 5-fluorouracil and interferon-alpha chemotherapy for lung metastasis of hepatocellular carcinoma after hepatic resection with portal and hepatic vein tumor thrombectomy. Hepatol Res 2005;33:320–324PubMedCrossRef
5.
Sevastianos VA, Deutsch M, Dourakis SP, et al. Pegylated interferon-2b-associated autoimmune thrombocytopenia in a patient with chronic hepatitis C. Am J Gastroenterol 2003;98:706–707PubMedCrossRef
6.
Takayama T, Makuuchi M, Yamazaki S. The role of splenectomy in patients with hepatocellular carcinoma and hypersplenism as an aid to hepatectomy. Nippon Geka Gakkai Zasshi 1989;90:1043–1048PubMed
7.
Lord JW Jr. The surgical management of secondary hypersplenisms. Surgery 1951;29:407–418PubMed
8.
El-Khishen MA, Henderson JM, Millikan WJ Jr, et al. Splenectomy is contraindicated for thrombocytopenia secondary to portal hypertension. Surg Gynecol Obstet 1985;160:233–238PubMed
9.
Mozes MF, Spigos DG, Pollak R, et al. Partial splenic embolization, an alternative to splenectomy—results of a prospective, randomized study. Surgery 1984;96:694–702PubMed
10.
Noguchi H, Hirai K, Aoki Y, et al. Changes in platelet kinetics after a partial splenic arterial embolization in cirrhotic patients with hypersplenism. Hepatology 1995;22:1682–1688PubMedCrossRef
11.
Taniai N, Onda M, Tajiri T, et al. Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE). Hepatogastroenterology 1999;46:2849–2853PubMed
12.
N’Kontchou G, Seror O, Bourcier V. Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients. Eur J Gastroenterol Hepatol 2005;17:179–184PubMedCrossRef
13.
Wu JM, Lai IR, Yuan RH, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 2004;187:720–723PubMedCrossRef
14.
Bolton-Maggs PHB, Stevens RF, Dodd NJ, et al. Guidelines for the diagnosis and management of hereditary spherocytosis. Br J Haematol 2004;126:455–474PubMedCrossRef
15.
Watanabe Y, Miyauchi K, Horiuchi A, et al. Concomitant laparoscopic splenectomy and cholecystectomy as an effective and minimally invasive treatment of pyruvate kinase deficiency with gallstones. Surg Endosc 2002;16:1493–1495CrossRef
16.
Kao SC, Wang G. Radiologic volumetry on a personal computer with a stereologic method. Acad Radiol 1998;5:665–669PubMedCrossRef
17.
Brandt CT, Rothbarth LJ, Kumpe D, et al. Splenic embolization in children; long-term efficacy. J Pediatr Surg 1989;24:642–644PubMedCrossRef
18.
Nio M, Hayashi Y, Sano N, et al. Long-term efficacy of partial splenic embolization in children. J Pediatr Surg 2003;38:1760–1762PubMedCrossRef
19.
Sakai T, Shiraki K, Inoue H, et al. Complications of partial splenic embolization in cirrhotic patients. Dig Dis Sci 2002;47:388–391PubMedCrossRef
20.
N’Kontchou G, Sero O, Bourcier V, et al. Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients. Eur J Gastroenterol Hepatol 2005;17:179–184PubMedCrossRef
21.
Shimada M, Hashizume M, Shirabe K, et al. A new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism. Performing a hepatectomy after a laparoscopic splenectomy. Surg Endosc 2000;14:127–130PubMed
22.
Hellman P, Arvidsson D, Rastad J. HandPort-assisted laparoscopic splenectomy in massive splenomegaly. Surg Endosc 2000;14:1177–1179PubMedCrossRef
23.
Rios R, Sangro B, Herrero I, et al. The role of thrombopoietin in the thrombocytopenia of patients with liver cirrhosis. Am J Gastroenterol 2005;100:1311–1316PubMedCrossRef
24.
Kawasaki T, Takeshita A, Souda K, et al. Serum thrombopoietin levels in patients with chronic hepatitis and liver cirrhosis. Am J Gastroenterol 1999;94:1918–1922PubMedCrossRef
25.
Sanjo A, Satoi J, Ohnishi A, et al. Role of elevated platelet-associated immunoglobulin G and hypersplenism in thrombocytopenia of chronic liver diseases. J Gastroenterol Hepatol 2003;18:638–644PubMedCrossRef
26.
Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg 2005;241:208–216PubMedCrossRef
27.
Harris W, Marcaccio M. Incidence of portal vein thrombosis after laparoscopic splenectomy. Can J Surg 2005;48:352–354PubMed
Metadata
Title
Significance of Laparoscopic Splenectomy in Patients with Hypersplenism
Authors
Yuji Watanabe, MD, PhD
Atsushi Horiuchi, MD, PhD
Motohira Yoshida, MD
Yuji Yamamoto, MD
Hiroki Sugishita, MD
Teru Kumagi, MD, PhD
Yoichi Hiasa, MD, PhD
Kanji Kawachi, MD, PhD
Publication date
01-03-2007
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 3/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-006-0504-8

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