Abstract
Purpose
Laparoscopic splenectomy (LS) has become the standard operative approach for splenectomy. Portal or splenic vein thrombosis (PSVT) is a serious and common complication after LS, and lethal complications of PSVT can occur when the portal vein is completely occluded by portal vein thrombosis (PVT). We aimed to clarify the predictors of PSVT after LS and to determine which of them were also predictors of PVT.
Methods
A total of 56 consecutive patients who underwent elective LS were enrolled in this study. The patients were divided into two groups based on the presence or absence of PSVT after LS. In addition, patients with PSVT were divided into two groups: a PVT group and a non-PVT group. The preoperative and intraoperative clinical data were compared among the groups.
Results
Thirty (53.6%) patients developed PSVT. The splenic vein diameter was the most useful predictor for the development of PSVT, and 10 mm was an accurate splenic vein diameter cut-off value for use as a predictive factor for PSVT. In addition, the splenic vein diameter was the most useful predictor of the development of PVT from splenic vein thrombosis (SVT), and 14 mm was found to be an accurate cut-off value.
Conclusion
PSVT is a common postoperative complication that is identified on enhanced computed tomography. The splenic vein diameter is not only a predictor of PSVT but also of the development of PVT from SVT.
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References
Rescorla FJ, West KW, Engum SA, Grosfeld JL. Laparoscopic splenic procedures in children: experience in 231 children. Ann Surg. 2007;246:683–7.
Taner T, Nagorney DM, Tefferi A, Habermann TM, Harmsen WS, Slettedahl SW, et al. Splenectomy for massive splenomegaly: long-term results and risks for mortality. Ann Surg. 2013;258:1034–9.
Kakinoki K, Okano K, Suto H, Oshima M, Hagiike M, Usuki H, et al. Hand-assisted laparoscopic splenectomy for thrombocytopenia in patients with cirrhosis. Surg Today. 2013;43:883–8.
Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: current concepts. World J Gastrointest Endosc. 2017;9:428 – 37.
Kawanaka H, Akahoshi T, Kinjo N, Harimoto N, Itoh S, Tsutsumi N, et al. Laparoscopic splenectomy with technical standardization and selection criteria for standard or hand-assisted approach in 390 patients with liver cirrhosis and portal hypertension. J Am Coll Surg. 2015;221:354 – 66.
Tada K, Ohta M, Saga K, Takayama H, Hirashita T, Endo Y, et al. Long-term outcomes of laparoscopic versus open splenectomy for immune thrombocytopenia. Surg Today. 2018;48:180–5.
Pietrabissa A, Moretto C, Antonelli G, Morelli L, Marciano E, Mosca F. Surg Endosc. 2004;18:1140–3.
Luoto TT, Pakarinen MP, Koivusalo A. Long-term outcomes after pediatric splenectomy. Surgery. 2016;159:1583–90.
Rottenstreich A, Kleinstern G, Spectre G, Da’as N, Ziv E, Kalish Y. Thromboembolic events following splenectomy: risk factors, prevention, management and outcomes. World J Surg. 2018;42:675 – 81.
Ikeda M, Sekimoto M, Takiguchi S, Kubota M, Ikenaga M, Yamamoto H, 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 – 16.
de’Angelis N, Abdalla S, Lizzi V, Esposito F, Genova P, Roy L, et al. Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy. Surgery. 2017;162:1219–30.
Zhe C, Jian-wei L, Jian C, Yu-dong F, Ping B, Shu-guang W, et al. Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study. J Gastrointest Surg. 2013;17:654–9.
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 – 40.
Kinjo N, Kawanaka H, Akahoshi T, Tomikawa M, Yamashita N, Konishi K, et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg. 2010;97:910–6.
Hirashita T, Ohta M, Kai S, Masuda T, Eguchi H, Iwashita Y, et al. Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension. Surg Today. 2011;41:1475–80.
Qian YY, Li K. The early prevention and treatment of PVST after laparoscopic splenectomy: a prospective cohort study of 130 patients. Int J Surg. 2017;44:147 – 51.
Zhang N, Yao Y, Xue W, Wu S. Early prophylactic anticoagulation for portal vein system thrombosis after splenectomy: a systemic review and meta-analysis. Biomed Rep. 2016;5:483 – 90.
Danno K, Ikeda M, Sekimoto M, Sugimoto T, Takemasa I, Yamamoto H, et al. Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy. Surgery. 2009;145:457–64.
Chaffanjon PC, Brichon PY, Ranchoup Y, Gressin R, Sotto JJ. Portal vein thrombosis following splenectomy for hematologic disease: prospective study with doppler color flow imaging. World J Surg. 1998;22:1082–6.
Stamou KM, Toutouzas KG, Kekis PB, Nakos S, Gafou A, Manouras A, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg. 2006;141:663–9.
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Kuroki, T., Kitasato, A., Tokunaga, T. et al. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today 48, 804–809 (2018). https://doi.org/10.1007/s00595-018-1655-6
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DOI: https://doi.org/10.1007/s00595-018-1655-6