Laparoscopic splenectomy for portal hypertension.

Abstract

BACKGROUND/AIMS:

Laparoscopic splenectomy is now increasingly being performed. However, controversy remains regarding the effectiveness of a laparoscopic splenectomy for patients with portal hypertension.

METHODOLOGY:

Seventy-three patients with portal hypertension who underwent a laparoscopic splenectomy from February 1992 until October 2000 were reviewed and the effectiveness of the procedures for portal hypertension was evaluated. Forty-two patients had esophagogastric varices and twenty had a concomitant hepatocellular carcinoma. The indications for surgery were bleeding tendency due to thrombocytopenia (n = 40), difficulty in receiving treatment for hepatocellular carcinoma due to thrombocytopenia (n = 18), and sclerotherapy-resistant esophagogastric varices (n = 15).

RESULTS:

A laparoscopic splenectomy was successfully performed in all the patients. The rate of conversion to conventional open surgery was 9.6% (7/73). The mean operative time was 210.1 +/- 101.9 minutes, and the estimated blood loss was 374.7 +/- 352.4 mL. There were no cases of mortality, and morbidity was encountered in 11.0% of patients. The increase in the platelet count correlated significantly to the spleen weight (P < 0.001). The platelet count had been maintained at over 10 x 10(4)/mm3 for over three years. Eighteen patients with hepatocellular carcinoma successfully underwent treatment for hepatocellular carcinoma after surgery and no recurrence of esophagogastric varices was encountered.

CONCLUSIONS:

A laparoscopic splenectomy resulted in the successful secondary treatment of hepatocellular carcinoma and esophagogastric varices. Portal hypertension was not a contraindication. A laparoscopic approach is therefore the procedure of choice for a splenectomy in portal hypertension.

• Authors: Makoto Hashizume, Morimasa Tomikawa, Tomohiko Akahoshi, Kazuo Tanoue, Norikazu Gotoh, Kozo Konishi, Keishi Okita, Norifumi Tsutsumi, Rinshun Shimabukuro, Shohei Yamaguchi, Keizo Sugimachi
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2002 May-Jun Vol. 49 Issue 45 Pg. 847-52 ISSN: 0172-6390 [Print] Greece
• PMID: 12064005 (Publication Type: Journal Article)

Topics

• Aged
• Carcinoma, Hepatocellular (complications)
• Female
• Humans
• Hypertension, Portal (complications, surgery)
• Laparoscopy
• Liver Neoplasms (complications)
• Male
• Middle Aged
• Retrospective Studies
• Splenectomy (methods)