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Recommended timing for surveillance ultrasonography to diagnose portal splenic vein thrombosis after laparoscopic splenectomy

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Abstract

Background

Symptomatic portal or splenic vein thrombosis (PSVT) is a rare but potentially lethal complication of laparoscopic splenectomy (LS). While routine postoperative duplex ultrasound surveillance can be used for early detection, the optimal timing is unknown. The aim of this study is to investigate the incidence and progression of asymptomatic PSVT 1 week and 1 month after LS.

Methods

Consecutive patients scheduled for LS for hematologic disease participated in this study. Patients underwent surveillance for PSVT using duplex ultrasonography 1 week and 1 month postoperatively.

Results

43 of 48 patients planning to undergo LS in the study period were enrolled, with 3 subsequently excluded, leaving 40 for further analysis. The indications for LS were benign disease in 31 [19 had immune thrombocytopenia purpura (ITP)] and malignant disease in 9. A hand-assisted technique was used in 12 cases. PSVT was diagnosed in 9/40 patients (22.5%). Seven (77.8%) were diagnosed by 1 week with ultrasound, of whom one had mild symptoms (fever and diarrhea). After anticoagulation, subsequent ultrasounds showed resolution or improvement in all seven patients. Thirty-three patients had a normal ultrasound result at 1 week. One of these patients also had a computed tomography (CT) scan that found a PSVT not seen on ultrasound. Twenty-seven patients returned for follow-up after normal 1-week imaging: 26 patients had an ultrasound at 1 month, with no new PSVT found. One additional patient did not return for subsequent ultrasound until 2 months later, when a new distal SVT was found; ultrasound at 6 months showed complete resolution without treatment.

Conclusion

The 1-week incidence of PSVT after LS was 8/40 (20%). The high incidence justifies ultrasonographic screening on postoperative day 7. If asymptomatic PSVT has not developed at this time, it is unlikely to develop by 1 month, and subsequent screening ultrasound at 1 month is not required.

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Acknowledgement

This work was supported by an unrestricted educational grant from Covidien Canada.

Disclosures

Dr. Gerald Fried received an honorarium from WL Gore in 2008. Drs. Tung Tran, Sebastian Demyttenaere, Gerry Polyhronopoulos, Chantal Séguin, Giovanni Artho, Liane Feldman, and Ms Pepa Kaneva have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, L9-313, Montreal, QC, H3G 1A4, Canada

    Tung Tran, Sebastian V. Demyttenaere, Gerry Polyhronopoulos, Gerald M. Fried & Liane S. Feldman

  2. Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, QC, Canada

    Tung Tran, Sebastian V. Demyttenaere, Gerry Polyhronopoulos, Pepa Kaneva, Gerald M. Fried & Liane S. Feldman

  3. Department of Medicine, Division of Hematology, McGill University Health Centre, Montreal, QC, Canada

    Chantal Séguin

  4. Department of Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada

    Giovanni P. Artho

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  1. Tung Tran
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  2. Sebastian V. Demyttenaere
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  3. Gerry Polyhronopoulos
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  7. Gerald M. Fried
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  8. Liane S. Feldman
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Corresponding author

Correspondence to Liane S. Feldman.

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Tran, T., Demyttenaere, S.V., Polyhronopoulos, G. et al. Recommended timing for surveillance ultrasonography to diagnose portal splenic vein thrombosis after laparoscopic splenectomy. Surg Endosc 24, 1670–1678 (2010). https://doi.org/10.1007/s00464-009-0828-1

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  • DOI: https://doi.org/10.1007/s00464-009-0828-1

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