Skip to main content
SpringerLink
Log in

Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension

  • Original Articles
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/Purpose

This study was conducted retrospectively to examine whether laparoscopic splenectomy is an effective procedure for patients with splenomegaly due to portal hypertension in comparison to patients with a normal-sized spleen.

Methods

From September 1994 to May 2005, we performed laparoscopic splenectomy in 50 patients at Wakayama Medical University Hospital, Japan. Of these, 17 patients with splenomegaly due to portal hypertension and 17 patients with idiopathic thrombocytopenic purpura (ITP) with normal-size spleen were enrolled in this study, in which we compared the surgical outcome between patients with splenomegaly due to portal hypertension and those without splenomegaly (ITP group).

Results

The mean operative time (splenomegaly due to portal hypertension vs ITP; 171 vs 165 min; P = 0.7433) and estimated blood loss (248 vs 258 ml; P = 0.5396) were similar in the two groups. There were two patients with complications (11.8%) in the patients with splenomegaly due to portal hypertension and five patients with complications (29.4%) in those with ITP. All patients with splenomegaly due to portal hypertension showed appropriate increases in the platelet count following surgery. No perioperative mortality occurred.

Conclusions

We concluded that laparoscopic splenectomy was an effective procedure for splenomegaly due to portal hypertension, with findings being similar to those observed in patients with a normal-sized spleen (such as patients with ITP).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med 1991;20:2263.

    PubMed  CAS  Google Scholar 

  2. Hashizume M, Sugimachi K, Ueno K. Laparoscopic splenectomy with an ultrasonic dissector. N Engl J Med 1992;327:438.

    PubMed  CAS  Google Scholar 

  3. Delaitre B, Maignien B, Icard P. Laparoscopic splenectomy. Br J Surg 1992;79:1334.

    Article  PubMed  CAS  Google Scholar 

  4. Hashizume M, Sugimachi K, Kitano S, Shimada M, Baba H, Ueno K, et al. Laparoscopic splenectomy. Am J Surg 1994;167:611–614.

    Article  PubMed  CAS  Google Scholar 

  5. Flowers JL, Lefor AT, Steers J, Heyman M, Graham SM, Imbembo AL. Laparoscopic splenectomy in patients with hematologic diseases. Ann Surg 1996;224:19–28.

    Article  PubMed  CAS  Google Scholar 

  6. Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, et al. Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 1998;228:568–578.

    Article  PubMed  CAS  Google Scholar 

  7. Schlinkert RT, Teotia SS. Laparoscopic splenectomy. Arch Surg 1999;134:99–103.

    Article  PubMed  CAS  Google Scholar 

  8. Rhodes M, Rudd M, O’Rourke N, Nathanson L, Fielding G. Laparoscopic splenectomy and lymph node biopsy for hematologic disorders. Ann Surg 1995;222:43–46.

    Article  PubMed  CAS  Google Scholar 

  9. Schlinkert RT, Mann D. Laparoscopic splenectomy offers advantages in selected patients with immune thrombocytopenic purpura. Am J Surg 1995;170:624–627.

    Article  PubMed  CAS  Google Scholar 

  10. Brunt LM, Langer JC, Quasebarth MA, Whitman ED. Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 1996;172:596–601.

    Article  PubMed  CAS  Google Scholar 

  11. Watson DI, Coventry BJ, Chin T, Gill PG, Malycha P. Laparoscopic versus open splenectomy for immune thrombocytopenic purpura. Surgery 1997;121:18–22.

    Article  PubMed  CAS  Google Scholar 

  12. Diaz J, Eisenstat M, Chung R. A case-controlled study of laparoscopic splenectomy. Am J Surg 1997;173:348–350.

    Article  PubMed  CAS  Google Scholar 

  13. Park A, Marcaccio M, Sternbach M, Witzke D, Fitzgerald P. Laparoscopic vs open splenectomy. Arch Surg 1999;134:1263–1269.

    Article  PubMed  CAS  Google Scholar 

  14. Targarona EM, Espert JJ, Balague C, Piulachs J, Artigas V, Trias M. Splenomegaly should not be considered a con traindication for laparoscopic splenectomy. Ann Surg 1998;228:35–39.

    Article  PubMed  CAS  Google Scholar 

  15. Nicholson IA, Falk GL, Mulligan SC. Laparoscopically assisted massive splenectomy. A preliminary report of the technique of early hilar devascularization. Surg Endosc 1998;12:73–75.

    Article  PubMed  CAS  Google Scholar 

  16. Greene AK, Hodin RA. Laparoscopic splenectomy for massive splenomegaly using a Lahey bag. Am J Surg 2001;181:543–546.

    Article  PubMed  CAS  Google Scholar 

  17. Heniford BT, Park A, Walsh RM, Kercher KW, Matthews BD, Frenette G, et al. Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter? Am Surg 2001;67:854–858.

    PubMed  CAS  Google Scholar 

  18. Kercher KW, Matthews BD, Walsh RM, Sing RF, Backus CL, Heniford BT. Laparoscopic splenectomy for massive splenomegaly. Am J Surg 2002;183:192–196.

    Article  PubMed  Google Scholar 

  19. Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 2003;238:235–240.

    PubMed  Google Scholar 

  20. Rosen M, Brody F, Walsh RM, Ponsky J. Hand-assisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly. Arch Surg 2002;137:1348–13452.

    Article  PubMed  Google Scholar 

  21. Ailawadi G, Yahanda A, Dimick JB, Bedi A, Mulholland MW, Colletti L, et al. Hand-assisted laparoscopic splenectomy in patients with splenomegaly or prior upper abdominal operation. Surgery 2002;132:689–696.

    Article  PubMed  Google Scholar 

  22. Miles WFA, Greig JD, Wilson RG, Nixon SJ. Technique of laparoscopic splenectomy with a powered vascular linear stapler. Br J Surg 1996;83:1212–1214.

    Article  PubMed  CAS  Google Scholar 

  23. Rothenberg SS. Laparoscopic splenectomy using the harmonic scalpel. J Laparoendosc Surg 1996;6(Suppl 1):S61–S63.

    PubMed  Google Scholar 

  24. Romano F, Caprotti R, Franciosi C, De Fina S, Colombo G, Uggeri F. Laparoscopic splenectomy using Ligasure. Preliminary experience. Surg Endosc 2002;16:1608–1611.

    Article  PubMed  CAS  Google Scholar 

  25. Belli G, Fantini C, Ciciliano F, D’Agostino A, Barberio M. Pancreaticoduodenectomy in portal hypertension: use of the Ligasure. J Hepatobiliary Pancreat Surg 2003;10:215–217.

    Article  PubMed  Google Scholar 

  26. Delaitre B. Laparoscopic splenectomy. The “hanged spleen” technique. Surg Endosc 1995;9:528–529.

    Article  PubMed  CAS  Google Scholar 

  27. Winslow ER, Brunt LM. Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 2003;134:647–655.

    Article  PubMed  Google Scholar 

  28. Poulin EC, Mamazza J, Schlachta CM. Splenic artery embolization before laparoscopic splenectomy. An update. Surg Endosc 1998;12:870–875.

    Article  PubMed  CAS  Google Scholar 

  29. Targarona EM, Espert JJ, Cerdan G, Balague C, Piulachs J, Sugranes G, et al. Effect of spleen size on splenectomy outcome. A comparison of open and laparoscopic surgery. Surg Endosc 1999;13:559–562.

    Article  PubMed  CAS  Google Scholar 

  30. Ohta M, Nishizaki T, Matsumoto T, Shimabukuro R, Sasaki A, Shibata K, et al. Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy. J Hepatobiliary Pancreat Surg 2005;12:433–437.

    Article  PubMed  Google Scholar 

  31. Xu CE, Zhang SG, Yu ZH, Li GX, Cao LL, Ruan CL, et al. Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone? J Hepatobiliary Pancreat Surg 2004;11:129–134.

    Article  PubMed  Google Scholar 

  32. Hashizume M, Tomikawa M, Akahoshi T, Tanoue K, Gotoh N, Konishi K, et al. Laparoscopic splenectomy for portal hypertension. Hepatogastroenterology 2002;49:847–852.

    PubMed  Google Scholar 

  33. Kercher KW, Carbonell AM, Heniford BT, Matthews BD, Cunningham DM, Reindollar RW. Laparoscopic splenectomy reverses thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension. J Gastrointest Surg 2004;8:120–126.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Takashi Hama, Katsunari Takifuji, Kazuhisa Uchiyama, Masaji Tani, Manabu Kawai & Hiroki Yamaue

Authors
  1. Takashi Hama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katsunari Takifuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuhisa Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masaji Tani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manabu Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroki Yamaue
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Hama, T., Takifuji, K., Uchiyama, K. et al. Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. J Hepatobiliary Pancreat Surg 15, 304–309 (2008). https://doi.org/10.1007/s00534-007-1232-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-007-1232-7

Key words

Search

Navigation