Abstract
Background
Laparoscopic splenectomy has become the standard procedure for the normal to moderately enlarged spleens. We performed this study to investigate the safety, feasibility, and effectiveness of laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis.
Methods
We performed a retrospective chart review of 24 cases of laparoscopic splenectomy (group 1), 24 cases of open splenectomy (group 2) for hypersplenism secondary to liver cirrhosis, and 68 cases of laparoscopic splenectomy for immune thrombocytopenic purpura (group 3). We performed comparisons between groups 1 and 2 and groups 1 and 3 in terms of demographic, intraoperative, postoperative variables, and changes in blood counts and liver function.
Results
Patients in groups 1 and 2 had comparable demographic characteristics, but those in group 1 had less estimated blood loss, fewer complications, and shorter duration of oral intake, and they required less analgesia and shorter post-hospital stays. In both groups, leukocyte and platelet counts increased significantly and transaminase and total bilirubin decreased postoperatively, but not significantly, and there was no significant difference between the two groups. Compared with group 3, patients in group 1 were older, had lower preoperative hemoglobin levels and leukocyte counts, poorer Child-Pugh class, required more operation time, and suffered more estimated blood loss; however, there were no statistically significant differences in terms of conversion rates, transfusion rates, complication rates, and postoperative course.
Conclusions
Laparoscopic splenectomy is a safe, feasible, and effective procedure for hypersplenism secondary to liver cirrhosis.
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References
NDDKD (1994) National Institute of Diabetes and Digestive and Kidney Diseases. Digestive diseases in the United States: epidemiology and impact. Publication number 94–1447. National Institutes of Health; Bethesda, MD
Schuppan D, Afdhal NH (2008) Liver cirrhosis. Lancet 371:838–851
Popa M, Vasilescu C (2010) Minimally invasive splenectomy for thrombocytopenia associated with liver cirrhosis. Chirurgia (Bucur) 105:15–20
Watanabe Y, Horiuchi A, Yoshida M, Yamamoto Y, Sugishita H, Kumagi T, Hiasa Y, Kawachi K (2007) Significance of laparoscopic splenectomy in patients with hypersplenism. World J Surg 31:549–555
Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach. Report of a case. Presse Med 20:2263
Hama T, Takifuji K, Uchiyama K, Tani M, Kawai M, Yamaue H (2008) Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. J Hepatobiliary Pancreat Surg 15:304–309
Zhu JH, Wang YD, Ye ZY, Zhao T, Zhu YW, Xie ZJ, Liu JM (2009) Laparoscopic versus open splenectomy for hypersplenism secondary to liver cirrhosis. Surg Laparosc Endosc Percutan Tech 19:258–262
Wu CC, Cheng SB, Ho WM, Chen JT, Yeh DC, Liu TJ, P’Eng FK (2004) Appraisal of concomitant splenectomy in liver resection for hepatocellular carcinoma in cirrhotic patients with hypersplenic thrombocytopenia. Surgery 136:660–668
Kercher KW, Carbonell AM, Heniford BT, Matthews BD, Cunningham DM, Reindollar RW (2004) Laparoscopic splenectomy reverses thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension. J Gastrointest Surg 8:120–126
Kawanaka H, Akahoshi T, Kinjo N, Konishi K, Yoshida D, Anegawa G, Yamaguchi S, Uehara H, Hashimoto N, Tsutsumi N, Tomikawa M, Koushi K, Harada N, Ikeda Y, Korenaga D, Takenaka K, Maehara Y (2009) Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism. J Hepatobiliary Pancreat Surg 16:749–757
Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12:876–878
Targarona EM, Espert JJ, Cerdan G, Balague C, Piulachs J, Sugranes G, Artigas V, Trias M (1999) Effect of spleen size on splenectomy outcome. A comparison of open and laparoscopic surgery. Surg Endosc 13:559–562
Poulin EC, Thibault C, Mamazza J (1995) Laparoscopic splenectomy. Surg Endosc 9:172–176 discussion 176–177
Garcia-Tsao G (2001) Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 120:726–748
Roy C (1988) Ultrasound of the abdomen (exercises in radiological diagnosis). Springer, Berlin
Anegawa G, Kawanaka H, Uehara H, Akahoshi T, Konishi K, Yoshida D, Kinjo N, Hashimoto N, Tomikawa M, Hashizume M, Maehara Y (2009) Effect of laparoscopic splenectomy on portal hypertensive gastropathy in cirrhotic patients with portal hypertension. J Gastroenterol Hepatol 24:1554–1558
Acknowledgments
The study was granted by the West China Hospital, Sichuan University.
Disclosures
Yun Qiang Cai, Jin Zhou, Xiao Dong Chen, Yi Chao Wang, Zhong Wu, and Bing Peng have no conflicts of interest or financial ties to disclose.
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Drs. Yun Qiang Cai and Jin Zhou contributed equally to this work.
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Cai, Y.Q., Zhou, J., Chen, X.D. et al. Laparoscopic splenectomy is an effective and safe intervention for hypersplenism secondary to liver cirrhosis. Surg Endosc 25, 3791–3797 (2011). https://doi.org/10.1007/s00464-011-1790-2
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DOI: https://doi.org/10.1007/s00464-011-1790-2