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Shi Z, Xiao K, Gao T, Jin S, Zhang C, Zhou B, Bai D, Jiang G. Comparison of Apixaban and Aspirin in Preventing Portal Vein Thrombosis after Laparoscopic Splenectomy for Cirrhotic Hypersplenism. Thromb Haemost 2024. [PMID: 39672198 DOI: 10.1055/a-2484-0747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2024]
Abstract
BACKGROUND Portal vein system thrombosis (PVST) is a frequent and possibly fatal concurrent disorder following splenectomy. The optimal anticoagulant to prevent PVST following splenectomy remains unclear. OBJECTIVES The purpose of this study was to compare the safety and efficacy of apixaban versus aspirin in preventing PVST after laparoscopic splenectomy (LS) for cirrhotic hypersplenism. METHODS In this single-center randomized controlled trial, 80 patients with liver cirrhosis who received LS were randomly allocated to two treatment arms that were treated with apixaban or aspirin for 6 months. The primary effectiveness outcome was PVST formation after LS. RESULTS We excluded four patients who withdrew from the study. The dynamic incidence of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in the 6 postoperative months were all significantly lower in the apixaban treatment arm compared to the aspirin treatment arm (all P <0.001). Significantly lower incidences of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in apixaban treatment arm started from postoperative day 7, month 1, and day 7 compared to the aspirin treatment arm respectively (all P <0.05). Multiple logistic regression analysis revealed that apixaban was an independent protective factor for PVST at postoperative month 3, as compared with aspirin (relative risk, 0.057; 95% confidence interval, 0.013-0.248; P <0.001). CONCLUSION Compared with aspirin, apixaban could earlier and more effectively prevent PVST following LS for cirrhotic hypersplenism. Apixaban can be chosen as a priority treatment option versus aspirin, contributing to a lower risk of PVST.
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Affiliation(s)
- Zhaobao Shi
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- The Yangzhou School of Clinical Medicine of Dalian Medical University, Dalian, Liaoning, China
| | - Kunqing Xiao
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
| | - Tianming Gao
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
| | - Shengjie Jin
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
| | - Baohuan Zhou
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
| | - Dousheng Bai
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
| | - Guoqing Jiang
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
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Joung GI, Bae JY, Kim JI, Kim JY, Song JH. Evaluation of clopidogrel, hypercoagulability, and platelet count in dogs undergoing splenectomy for splenic masses. Vet Q 2024; 44:1-8. [PMID: 38823415 PMCID: PMC11146242 DOI: 10.1080/01652176.2024.2347926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/21/2024] [Indexed: 06/03/2024] Open
Abstract
Dogs that had splenectomy are predisposed to fatal thrombotic conditions, and thrombocytosis is a risk factor for post-splenectomy hypercoagulability. However, in veterinary medicine, there are no specific therapeutic approaches for managing this hypercoagulability. This study aimed to determine the preventive effect of clopidogrel on post-operative hypercoagulability during the first 2 weeks post-splenectomy in dogs with splenic masses. This study included 12 dogs that had splenectomy. Seven dogs received no treatment (group A), and five were treated with clopidogrel (group B). Clopidogrel was loaded at 10 mg/kg on day 2 and continued at 2 mg/kg until day 14. Blood samples were collected on the day of surgery and 2, 7, and 14 days after splenectomy in both groups. In group B, thromboelastography (TEG) was performed on the same days. In group A, there was significant elevation of platelet counts on days 7 (p = 0.007) and 14 (p = 0.001) compared to day 0. In group B, the platelet counts were significantly elevated on day 7 (p = 0.032) but no significant difference was found on day 14 compared to day 0. Platelet counts on day 14 were significantly higher in group A than in group B (p = 0.03). The lower platelet counts were correlated with alterations in TEG parameters, and no significant differences were found in the K and α-angle values at all postoperative assessment points compared to day 0. Our study suggests that clopidogrel may reduce post-operative thrombocytosis and hypercoagulability in dogs that undergo splenectomy for splenic masses.
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Affiliation(s)
- Guk-Il Joung
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Jeong-Yeol Bae
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Jung-Il Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Jin-Young Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Joong-Hyun Song
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
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Baldari L, Boni L, Giuliani B, Cassinotti E. Porto-spleno-mesenteric venous thrombosis after elective splenectomy: a retrospective cohort study. Front Immunol 2023; 14:1216283. [PMID: 37928557 PMCID: PMC10625444 DOI: 10.3389/fimmu.2023.1216283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Elective splenectomy is the main treatment for a wide range of haematological diseases. Porto-spleno-mesenteric venous thrombosis represents one of the most severe complications of this procedure. The aim of this study was to evaluate risk factors associated with development of porto-spleno-mesenteric venous thrombosis after elective splenectomy. Methods All cases of elective splenectomy carried out from April 1st 2017 to January 31st 2023 were included in this single centre retrospective cohort study. Patients' demographics and perioperative data were analysed and correlated with the incidence of postoperative thrombosis. All patients underwent postoperative doppler ultrasound screening for thrombosis. Analysis was performed using SPSS 28, with p-value < 0.05 considered significant. Results Twenty-two patients (10 women, 12 men) underwent splenectomy during the study period. Indications were: immune thrombocytopenia (n: 6), myeloproliferative disorder (n: 6), hereditary spherocytosis (n: 4), thalassemia (n: 1), lymphoma (n: 1), leukaemia (n: 1), other malignancies (n: 3). Six patients developed porto-spleno-mesenteric venous thrombosis and only 2 of them were symptomatic. Patients were treated with anticoagulation therapy with complete resolution. Analysis identified three main factors associated with thrombosis: spleen diameter (p = 0.03), myeloproliferative disorder (p = 0.02), intraoperative platelet transfusion (p = 0.002) and intraoperative red blood cells transfusion (p = 0.009). Conclusion Standardized postoperative screening allows prompt diagnosis and treatment of porto-spleno-mesenteric venous thrombosis even in asymptomatic cases. Patient with splenomegaly and affected by myeloproliferative disorder have a greater risk to develop this complication.
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Affiliation(s)
- Ludovica Baldari
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Boni
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunitá, Univeristy of Milan, Milan, Italy
| | - Beatrice Giuliani
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Cassinotti
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunitá, Univeristy of Milan, Milan, Italy
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Zheng Z, Yu Q, Peng H, Huang L, Zhang W, Shen Y, Feng H, Jing W, Zhang Q. Nomogram-based prediction of portal vein system thrombosis formation after splenectomy in patients with hepatolenticular degeneration. Front Med (Lausanne) 2023; 10:1103223. [PMID: 36910478 PMCID: PMC9996067 DOI: 10.3389/fmed.2023.1103223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Splenectomy is a vital treatment method for hypersplenism with portal hypertension. However, portal venous system thrombosis (PVST) is a serious problem after splenectomy. Therefore, constructing an effective visual risk prediction model is important for preventing, diagnosing, and treating early PVST in hepatolenticular degeneration (HLD) surgical patients. Methods Between January 2016 and December 2021, 309 HLD patients were selected. The data were split into a development set (215 cases from January 2016 to December 2019) and a validation set (94 cases from January 2019 to December 2021). Patients' clinical characteristics and laboratory examinations were obtained from electronic medical record system, and PVST was diagnosed using Doppler ultrasound. Univariate and multivariate logistic regression analyses were used to establish the prediction model by variables filtered by LASSO regression, and a nomogram was drawn. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the differentiation and calibration of the model. Clinical net benefit was evaluated by using decision curve analysis (DCA). The 36-month survival of PVST was studied as well. Results Seven predictive variables were screened out using LASSO regression analysis, including grade, POD14D-dimer (Postoperative day 14 D-dimer), POD7PLT (Postoperative day 7 platelet), PVD (portal vein diameter), PVV (portal vein velocity), PVF (portal vein flow), and SVD (splenic vein diameter). Multivariate logistic regression analysis revealed that all seven predictive variables had predictive values (P < 0.05). According to the prediction variables, the diagnosis model and predictive nomogram of PVST cases were constructed. The AUC under the ROC curve obtained from the prediction model was 0.812 (95% CI: 0.756-0.869) in the development set and 0.839 (95% CI: 0.756-0.921) in the validation set. Hosmer-Lemeshow goodness-of-fit test fitted well (P = 0.858 for development set; P = 0.137 for validation set). The nomogram model was found to be clinically useful by DCA. The 36-month survival rate of three sites of PVST was significantly different from that of one (P = 0.047) and two sites (P = 0.023). Conclusion The proposed nomogram-based prediction model can predict postoperative PVST. Meanwhile, an earlier intervention should be performed on three sites of PVST.
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Affiliation(s)
- Zhou Zheng
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Qingsheng Yu
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Hui Peng
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Long Huang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Wanzong Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Yi Shen
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Hui Feng
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Wenshan Jing
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Qi Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
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Predictors of portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection in hepatitis B cirrhosis: a prospective study. Surg Endosc 2022; 36:4090-4098. [PMID: 34518951 DOI: 10.1007/s00464-021-08730-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/06/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The thrombosis of the main and intrahepatic branches of the portal vein (TMIP) is potentially lethal and deemed a common complication following laparoscopic splenectomy and azygoportal disconnection (LSD) in patients with cirrhosis and portal hypertension (PH). The predictors of TMIP after LSD remain unclear. The aim of this prospective study was to explore the predictive and risk factors for TMIP after LSD in cirrhotic patients with PH caused only by hepatitis B virus. METHODS From September 2014 to March 2017, we enrolled 115 patients with hepatitis B cirrhosis and PH who successfully underwent LSD. Patients were subdivided into a TMIP group and a non-TMIP group. Univariate and multivariate logistic regression analysis was conducted on 24 items of demographic and preoperative data, to explore the risk factors of TMIP. RESULTS Twenty-nine (25.22%) patients developed TMIP on postoperative day (POD) 7 and 26 (22.81%) patients developed TMIP on POD 30. From POD 7 to POD 30, 12 patients who did not have TMIP at POD 7 were newly diagnosed with TMIP, with portal vein diameter 15.05 ± 2.58 mm. Another 14 patients in whom TMIP had resolved had portal vein diameter 14.02 ± 1.76 mm. Univariate analysis and multivariate logistic regression revealed that portal vein diameter ≥ 13 mm [relative risk (RR) 5.533, 95% confidence interval (CI) 1.222-25.042; P = 0.026] and portal vein diameter ≥ 15 mm (RR 3.636, 95% CI 1.466-9.021; P = 0.005) were significant independent risk factors for TMIP on POD 7 and 30, respectively. CONCLUSION Portal vein diameter ≥ 13 mm and ≥ 15 mm were significant independent predictors for TMIP after LSD in patients with hepatitis B cirrhosis and PH on POD 7 and POD 30, respectively. TRIAL REGISTRATION We registered our research at https://www. CLINICALTRIALS gov/ . The name of research registered is "Warfarin Prevents Portal Vein Thrombosis in Patients After Laparoscopic Splenectomy and Azygoportal Disconnection." The trial registration identifier at clinicaltrials.gov is NCT02247414.
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Alkassis S, Zaher N, Kaloti Z, Levine D. Idiopathic portal vein thrombosis not related to hepatic disease or malignancy. BMJ Case Rep 2021; 14:e245620. [PMID: 34753728 PMCID: PMC8578946 DOI: 10.1136/bcr-2021-245620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/03/2022] Open
Abstract
Acute portal vein thrombosis (PVT) is a rare disorder defined by the sudden occlusion of the portal vein, which could be partial or complete. Prothrombotic states, inherited or acquired, are thought to be the cause in patients without cirrhosis or malignancy. However, the aetiology of some cases remains idiopathic despite a multidisciplinary diagnostic approach. The initial diagnostic modality to confirm PVT is either contrast-enhanced abdominal (CT) or MRI; as it can identify predisposing factors, and detect evidence of complications. Eliciting the underlying aetiology is critical to guide overall management and prevent future recurrence. The purpose of treatment is to stop thrombus extension and achieve portal vein patency by anticoagulation to optimise outcomes. Herein, we present an unusual case of spontaneous PVT in a young woman. We will also discuss the evaluation of patients without obvious aetiology.
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Affiliation(s)
- Samer Alkassis
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Nathan Zaher
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Zaid Kaloti
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Diane Levine
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Yang C, Liu J, Shi Q, Huang S, Zhou C, Wang Y, Li T, Chen Y, Xiong B. Effect of splenectomy on the outcomes in patients with cirrhosis receiving transjugular intrahepatic portosystemic shunt. J Gastroenterol Hepatol 2021; 36:2893-2902. [PMID: 33973270 PMCID: PMC8518516 DOI: 10.1111/jgh.15543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/28/2021] [Accepted: 05/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Patients indicated to transjugular intrahepatic portosystemic shunt (TIPS) placement may have splenectomy history due to thrombocytopenia. This study aimed to evaluate the effect of prior splenectomy on TIPS procedure and post-TIPS outcomes. METHODS We conducted a longitudinal analysis based on a cohort of 284 patients with cirrhosis submitted to TIPS; 74 patients had splenectomy history (splenectomy group) and 210 did not (non-splenectomy group). Cox proportional hazards models were used to evaluate the association between splenectomy and outcomes after TIPS. The primary outcome was shunt dysfunction. Secondary outcomes included all-cause mortality, clinical recurrence of bleeding or ascites, and overt hepatic encephalopathy (OHE). RESULTS During a median follow-up of 16.2 months, the splenectomy group had significantly lower rates of postoperative shunt patency (85.5% vs 95.6% at 1 year and 75.2% vs 86.5% at 2 years; adjusted hazard ratio [HR] 2.53; 95% confidence interval [CI] 1.21-5.12; P = 0.01) and higher risk of OHE (adjusted HR 1.82; 95% CI 1.03-3.54; P = 0.04). But the risk of mortality (adjusted HR 0.87; 95% CI 0.41-1.87; P = 0.73) and recurrent bleeding or ascites (adjusted HR 1.17; 95% CI 0.53-2.35; P = 0.77) showed no statistical difference. Multivariate analysis confirmed splenectomy history and endoscopic therapy as independent predictors of shunt dysfunction. Besides, pre-TIPS splenectomy increased the difficulty of TIPS procedure by complicating portal vein puncture. CONCLUSIONS For patients with cirrhosis submitted to TIPS, prior splenectomy complicated TIPS procedure and increased the risk of shunt dysfunction and OHE after TIPS, but was not significantly associated with the occurrence of mortality and recurrent bleeding or ascites.
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Affiliation(s)
- Chongtu Yang
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Qin Shi
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Songjiang Huang
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Tongqiang Li
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Yang Chen
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Hubei Province Key Laboratory of Molecular ImagingWuhanChina
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Huang L, Yu Q, Peng H. Hemorheological Alteration in Patients with Cirrhosis Clinically Diagnosed with Portal Vein System Thrombosis After Splenectomy. Med Sci Monit 2021; 27:e931157. [PMID: 34120137 PMCID: PMC8210620 DOI: 10.12659/msm.931157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Portal vein system thrombosis (PVST) is a common and serious complication after splenectomy. Key factors, including wider diameters of the portal vein, decreased liver function, and high flow volume of portosystemic collateral vessel, are recognized PVST risks. Relationships between PVST and altered hemorheology, including increased plasma viscosity, remain unclear. We investigated hemorheological alterations and explored risk factors of PVST in patients with cirrhosis after splenectomy. Material/Methods Data on patients with cirrhosis who underwent splenectomy were collected retrospectively from January 2018 to June 2020. Color Doppler ultrasonography was performed after splenectomy. Hemorheological indexes were compared between groups. Receiver operating characteristic (ROC) analysis was conducted to analyze risk factor cutoff values. Univariate and multivariate analyses were conducted to explore risk factors of PVST. Results A total of 50 patients were divided into a PVST group (n=30) and control group (n=20). Hemorheological indexes of activated partial thromboplastin time, fibrinogen degradation products (FDP), D-dimer, middle shear rates 50 and 30, low shear rates 5 and 1, and hematocrit in the PVST group were significantly higher than those of the control group (P<0.05). FDP and low shear rate 1 were found to be risk factors of PVST after splenectomy by multivariate analysis. ROC analysis showed that the cutoff points for FDP and low shear rate 1 were ≥38.6 ug/mL and ≥16.855 mPa.s, respectively. Conclusions PVST after splenectomy is closely related to hemorheological alteration. FDP and low shear rate 1 may be valuable markers of PVST.
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Affiliation(s)
- Long Huang
- Department of No. 1 Surgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China (mainland)
| | - Qingsheng Yu
- Department of No. 1 Surgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China (mainland)
| | - Hui Peng
- Department of No. 1 Surgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China (mainland)
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Abduljalil M, Saunders J, Doherty D, Dicks M, Maher C, Mehigan B, Flavin R, Flynn CM. Evaluation of the risk factors for venous thromboembolism post splenectomy - A ten year retrospective cohort study in St James's hospital. Ann Med Surg (Lond) 2021; 66:102381. [PMID: 34026114 PMCID: PMC8131975 DOI: 10.1016/j.amsu.2021.102381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Splenectomy is a surgical intervention for a variety of indications; benign and malignant. Complications of this procedure include Venous thromboembolism (VTE) and infection. The incidence of VTE post-surgery has been reported between 0.8%-3% depending on the type of surgery. A higher incidence of abdominal VTE was reported post splenectomy (6-11%). However, there is limited literature regarding the risk factors for post splenectomy VTE and the optimal strategy for thromboprophylaxis. Objective The primary objective of the study was to evaluate the incidence of VTE post splenectomy and to identify the pre-operative, intra-operative and post-operative risk factors. The secondary objective was to assess the local compliance with post-splenectomy prophylactic antibiotics and vaccination protocols. Methods We conducted a retrospective observational study. All patients who had a splenectomy in St James's Hospital between January 2007 and June 2017 were included and reviewed. Statistical analysis was carried out using SPSS statistical package. Results 85 patients were involved in the study. The main indications for splenectomy were benign haematology, malignant haematology, solid tumours, traumatic and spontaneous rupture. 6/85 patients developed VTE (7.06%).High BMI ≥ 30 was associated with increased risk of VTE (p = 0.007), while the use of post-operative prophylactic anticoagulation was associated with reduced risk (p = 0.005). Other factors including age >50 years, female gender, presence of active malignancy and splenomegaly were associated with increased VTE risk with no statistical significance. All VTE's occurred in elective versus emergency splenectomy. Laparoscopic splenectomy was associated with higher risk of VTE than open splenectomy. 97% of patients were prescribed prophylactic antibiotics on discharge, but only 88% had received recommended vaccinations. Conclusion Venous thromboembolism is common post splenectomy. Our data showed that BMI ≥30 was associated with a statistically significant increased risk of VTE, while the use of prophylactic anticoagulation was associated with reduced risk. Further prospective studies with larger samples are warranted and a splenectomy care plan may be helpful.
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Affiliation(s)
- Manal Abduljalil
- Department of Haematology, St James's Hospital, James Street, Dublin, D03 R2WY, Ireland
| | - Jean Saunders
- Director of Centre for Support Training Analysis Research, University of Limerick, Limerick, Ireland
| | - Dearbhla Doherty
- Department of Haematology, St James's Hospital, James Street, Dublin, D03 R2WY, Ireland
| | - Marthinus Dicks
- Department of Haematology, St James's Hospital, James Street, Dublin, D03 R2WY, Ireland
| | - Catherine Maher
- HOPE Directorate, St James's Hospital, James Street, Dublin, D03 R2WY, Ireland
| | - Brian Mehigan
- Department of Surgery, St James's Hospital, James Street, Dublin, D03 R2WY, Ireland
| | - Richard Flavin
- Department of Histology, St James's Hospital, James's Street, Dublin, D03 R2WY, Ireland
| | - Catherine M Flynn
- Department of Haematology, St James's Hospital, James Street, Dublin, D03 R2WY, Ireland
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Klompas AM, Boswell MR, Plack DL, Smith MM. Thrombocytopenia: Perioperative Considerations for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:893-905. [PMID: 33707107 DOI: 10.1053/j.jvca.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
The etiologies of thrombocytopenia in patients presenting for cardiac surgery are extensive, but clinically relevant conditions generally can be categorized by those related to decreased platelet production or increased platelet destruction. Many causes require mere acknowledgment and availability of allogeneic platelet transfusion; others have unique considerations for which providers should be familiar. The purpose of this review is to provide an overview of the common causes of thrombocytopenia, summarize the literature, and discuss perioperative considerations for patients undergoing cardiac surgery.
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Affiliation(s)
- Allan M Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN
| | - Michael R Boswell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN
| | - Daniel L Plack
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN.
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11
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Deng ZC, Jiang WZ, Chen L, Tang XD, Liu SH. Laparoscopic VS. Open splenectomy and oesophagogastric devascularisation for liver cirrhosis and portal hypertension: A retrospective cohort study. Int J Surg 2020; 80:79-83. [DOI: 10.1016/j.ijsu.2020.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 12/29/2022]
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12
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Risk Factors and Anticoagulation Effects of Portal Vein System Thrombosis After Laparoscopic Splenectomy in Patients With or Without Cirrhosis. Surg Laparosc Endosc Percutan Tech 2020; 29:498-502. [PMID: 31436648 DOI: 10.1097/sle.0000000000000710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The clinical data of 149 patients who underwent successful laparoscopic splenectomy (LS) between January 2014 and September 2017 were analyzed in the present study. The incidence of portal vein system thrombosis (PVST) in patients with and without cirrhosis was 32.0% and 9.5%, respectively. Multiple logistic regression analysis revealed that the ratio of the postoperative maximum platelet (PLT) count to the preoperative PLT count (r=1.144; P=0.007) was the risk factor for PVST in all patients after LS. Of patients who received prophylactic anticoagulation, 9 and 6 cases of PVST in patients with and without cirrhosis, respectively, (37.5% vs. 85.7%; P=0.037) resolved during hospitalization. In patients who underwent LS, a PLT count increasing to >8 times baseline levels after surgery was the risk factor for PVST after LS, and the sensitivity to anticoagulation postoperatively was significantly higher in patients without cirrhosis than in those with cirrhosis.
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13
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Smith BB, Boswell MR, Matzek LJ, Smith MM. Thrombocytosis: Perioperative Considerations for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:772-781. [PMID: 31416676 DOI: 10.1053/j.jvca.2019.07.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/21/2019] [Accepted: 07/11/2019] [Indexed: 11/11/2022]
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Comparison of Efficacy of Laparoscopic and Open Splenectomy Combined With Selective and Nonselective Pericardial Devascularization in Portal Hypertension Patients. Surg Laparosc Endosc Percutan Tech 2019; 28:401-403. [PMID: 30260914 DOI: 10.1097/sle.0000000000000581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent advances in laparoscopic techniques have demonstrated that laparoscopy is superior for managing portal hypertension. This study aimed to compare the efficacy of laparoscopic splenectomy plus selective pericardial devascularization (LSSD) and open splenectomy and nonselective pericardial devascularization (OSD) in patients with portal hypertension. METHODS A total of 127 patients with portal hypertension underwent either LSSD or OSD at Jingzhou Central Hospital from January 2014 to December 2016. A total of, 55 patients received LSSD, including 29 male and 26 female individuals (age, 56.0±11.6 y); 72 patients received OSD, including 45 male and 27 female individuals (age, 53.4±10.9 y). The parameters of operation and outcomes were measured and compared. RESULTS Intraoperative blood loss, postoperative complications, and hospital stay were significantly lower in LSSD group but operation time was significantly lower in OSD group. Postoperative Child-Pugh score was significantly lower in LSSD group than in OSD group. CONCLUSIONS LSSD is a safe and effective treatment for liver cirrhosis patients with portal hypertension.
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Bai DS, Xia BL, Zhang C, Ye J, Qian JJ, Jin SJ, Jiang GQ. Warfarin versus aspirin prevents portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection: A randomized clinical trial. Int J Surg 2019; 64:16-23. [PMID: 30851458 DOI: 10.1016/j.ijsu.2019.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/26/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Portal vein system thrombosis (PVST) is a common, potentially life-threatening complication after splenectomy. The optimal recognized anticoagulation drugs for preventing PVST in cirrhotic patients after splenectomy remain unclear. The aim of this study is to evaluate the safety and efficacy of warfarin in preventing PVST after laparoscopic splenectomy and azygoportal disconnection (LSD). METHODS In this randomized controlled single-center study, 80 cirrhotic patients who underwent LSD were randomly assigned to 2 years of treatment with either warfarin (n = 40) or aspirin (n = 40). The primary outcome was prevention of PVST. Sonographers and radiologists who assessed outcomes were blinded to group assignments. Intention-to-treat analysis was performed. RESULTS During the first year, excluding two patients withdrawing from the study, 15 of the 39 warfarin-treated patients (38.5%) and five of the 39 aspirin-treated patients (12.8%) did not develop PVST (P = 0.010). The incidence of PVST in the first 2 postoperative years was significantly lower in the warfarin group than in the aspirin group (F = 7.360, P = 0.008). The warfarin group in paired within-group comparisons had significantly greater improvements in total bilirubin and albumin levels at baseline versus at 6 months postoperatively and in creatinine levels at baseline versus at 12, 18, and 24 months postoperatively respectively (all P < 0.05). In contrast, those paired comparisons of the aspirin group showed no significant differences (all P > 0.05). CONCLUSIONS Warfarin therapy was safe and effective and significantly reduced the risk of PVST after LSD, compared with aspirin treatment. Warfarin treatment was associated with better liver function protection and renal function improvement than aspirin treatment.
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Affiliation(s)
- Dou-Sheng Bai
- Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China
| | - Bing-Lan Xia
- Departments of Ultrasound, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China
| | - Chi Zhang
- Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China
| | - Jing Ye
- Department of Medical Imaging, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China
| | - Jian-Jun Qian
- Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China
| | - Sheng-Jie Jin
- Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China
| | - Guo-Qing Jiang
- Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China.
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16
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Postsplenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv): A single institutional series, comprehensive systematic review of a literature and suggested classification. Am J Surg 2018; 216:1192-1204. [DOI: 10.1016/j.amjsurg.2018.01.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
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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; 42:675-681. [PMID: 28808782 DOI: 10.1007/s00268-017-4185-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Thromboembolic events following splenectomy are not uncommon. However, the role of thromboprophylaxis and risk factors for thrombosis, as well as the clinical course and outcomes, are not well characterized. METHODS A retrospective review of individuals who underwent splenectomy between January 2006 and December 2015 in two university hospitals. RESULTS Overall, 297 patients underwent splenectomy [open splenectomy (n = 199), laparoscopic splenectomy (n = 98)]. Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 h after surgery until discharge) was provided for all patients. One hundred and sixteen patients (39%) also received an extended thromboprophylaxis course of enoxaparin for 2-4 weeks after discharge. Twenty-three patients (7.7%) experienced thrombotic complications following splenectomy, including 16 cases (5.4%) of portal-splenic mesenteric venous thrombosis (PSMVT), 5 (1.7%) pulmonary embolism and 2 (0.7%) deep vein thrombosis. Longer operative time (mean operative time of 405 vs. 273 min, P = 0.03) was independently associated with PSMVT. Post-splenectomy thrombocytosis was not associated with thrombosis (P = 0.41). The overall thrombosis rate was significantly lower in patients who received an extended thromboprophylaxis course following splenectomy (3.4 vs. 10.5%, P = 0.02). Complete resolution of thrombosis was observed in most cases (n = 20, 87.0%), with no recurrent thrombosis during a mean follow-up of 38 ± 25 months. CONCLUSIONS Thromboembolic complications, mainly PSMVT, are common following splenectomy. Longer operative time was associated with thrombosis. Significantly lower rates of thrombosis were found in patients who received an extended thromboprophylaxis course.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Geffen Kleinstern
- Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Galia Spectre
- Institute of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nael Da'as
- Internal Medicine D, Hematology Unit, Sha'are Zedek Medical Center, Jerusalem, Israel
| | - Esther Ziv
- Institute of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
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Kuroki T, Kitasato A, Tokunaga T, Takeshita H, Taniguchi K, Maeda S, Fujioka H. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today 2018; 48:804-809. [PMID: 29569060 DOI: 10.1007/s00595-018-1655-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
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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Affiliation(s)
- Tamotsu Kuroki
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan.
| | - Amane Kitasato
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Takayuki Tokunaga
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Hiroaki Takeshita
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Ken Taniguchi
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Shigeto Maeda
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Hikaru Fujioka
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
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Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc 2017; 9:428-437. [PMID: 28979707 PMCID: PMC5605342 DOI: 10.4253/wjge.v9.i9.428] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes.
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Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
| | - George Bagias
- Clinic for General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
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20
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de'Angelis N, Abdalla S, Lizzi V, Esposito F, Genova P, Roy L, Galacteros F, Luciani A, Brunetti F. Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy. Surgery 2017; 162:1219-1230. [PMID: 28919051 DOI: 10.1016/j.surg.2017.07.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/09/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Optimal modalities for diagnosis, treatment, and surveillance of portal or splenic vein thrombosis have not yet been defined. The present retrospective study aimed to investigate the role of computed tomography performed systematically before and after laparoscopic splenectomy to assess the incidence of portal or splenic vein thrombosis, predictors, and outcomes. METHODS Computed tomography scans were obtained from 170 patients undergoing elective laparoscopic splenectomy between 2005 and 2015. Pre- and postoperative splenic vein diameter was measured at the splenoportal junction and at a distance of 2, 4, 6 cm from it. Univariate and multivariate analyses were used to identify portal or splenic vein thrombosis risk factors and predictors of treatment outcome. RESULTS Overall, 68.2% of patients had benign hematologic diseases; 64.1% showed splenomegaly. Portal or splenic vein thrombosis occurred in 53.5% of patients (91/170), of whom 49.5% were asymptomatic. Preoperative splenic vein diameter measurements at 2, 4, and 6 cm from the splenoportal junction were significantly greater in portal or splenic vein thrombosis patients than in no-portal or splenic vein thrombosis patients. Patients with splenic vein diameter ≥8 mm at all measured sites had a greater risk of developing portal or splenic vein thrombosis (P = .009; odds ratio, 2.57; 95% confidence interval, 1.26-5.23). The majority of thromboses involved the distal splenic vein (45.1%, 41/91), and 41.7% of patients had thromboses located in multiple sites. Fully 71.4% showed complete resolution of portal or splenic vein thrombosis. Thrombus location at a single site predicted a favorable treatment outcome (P < .0001). CONCLUSION Portal or splenic vein thrombosis is a frequent complication of splenectomy that occurs asymptomatically in half of cases. Computed tomography could have an important role in identifying patients at risk of developing portal or splenic vein thrombosis as well as in predicting portal or splenic vein thrombosis resolution.
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Affiliation(s)
- Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Solafah Abdalla
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Vincenzo Lizzi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Francesco Esposito
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Pietro Genova
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Lydia Roy
- Department of Hematology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Frédéric Galacteros
- Department of Internal Medicine, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Alain Luciani
- Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Francesco Brunetti
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.
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Portal Vein Thrombosis After Splenic and Pancreatic Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 906:241-251. [PMID: 27638624 DOI: 10.1007/5584_2016_119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The portal vein is formed by the confluence of the splenic and superior mesenteric veins, which drain the spleen and small intestine respectively. Occlusion of the portal vein by thrombus typically occurs in patients with cirrhosis and/or prothrombotic disorders. However, portal vein thrombosis (PVT) can also happen after determined surgeries. Moreover, PVT can have serious consequences depending on the location and extent of the thrombosis, including hepatic ischemia, intestinal ischemia, portal hypertension… In this chapter, we will review the incidence, management and prophylaxis of PVT after splenectomy, pancreas transplantation, pancreatic surgery and in the setting of acute and chronic pancreatitis.
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22
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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; 44:147-151. [PMID: 28583895 DOI: 10.1016/j.ijsu.2017.05.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/29/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND After laparoscopic splenectomy (LS) in patients with cirrhotic and hypersplenism, there is highly risk of suffering from portal vein system thrombosis (PVST) complication. This study is aimed to investigate the risk factors of PVST and study the anticoagulation effect on the prevention of PVST after LS. MATERIALS AND METHODS We retrospectively observed 130 patients who performed LS from February 2009 to December 2016. Patients were classified into the anticoagulation group (73 patients) and the non-anticoagulation group (57 patients). At the same time, the non-PVST and PVST groups were used to analyze the factors of thrombosis. RESULTS We analyzed the risk factors of PVST, the mean platelet volume (MPV), platelet count (PLT), plasma d-dimer, thickness of spleen and portal vein diameter were statistically significant (P < 0.05) between PVST group and non-PVST group. Compared with the non-anticoagulant group, anticoagulant group had a lower incidence of PVST (P = 0.044), a significant lower PLT (P = 0.001), a notable lower mean platelet volume (P = 0.006), and an obvious lower d-dimer (P = 0.001) after LS. And prothrombin time (PT) and international normalized ratio (INR) were significant increase after treated with anticoagulant drugs. Multiple logistic regression analysis reported that PLT, d-dimer, portal vein diameter and thickness of spleen were the risk factors of PVST, however the anticoagulant drug was an independent protective factor for PVST (P = 0.001). CONCLUSIONS Anticoagulant drug significantly decreased the incidence rate of PVST in patients with cirrhotic and portal hypertension after LS.
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Affiliation(s)
- Yu-Yuan Qian
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Kun Li
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
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Hassenpflug M, Tjaden C, Hinz U, Volpert J, Hackert T, Büchler MW, Werner J. Hypercoagulability after distal pancreatectomy: Just meaningless alterations? Pancreatology 2017; 17:478-483. [PMID: 28372957 DOI: 10.1016/j.pan.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/05/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Perioperative and short-term postoperative parameters are similar comparing spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). But there are no sound data evaluating the long term risk of postoperative thromboses and infectious complications after splenectomy. The present study evaluated whether the coagulation status differs in patients after SPDP and DPS, and whether that matters clinically. METHODS A total of 41 patients after DP (SPDP = 20; DPS = 21) were followed up, focusing on alterations of patient coagulation and immune status. To assess kinetics of the coagulation process, qualitative tests (multiple platelet function analyzer, rotational thrombelastography) were used in addition to global coagulation tests. RESULTS Coagulation tests revealed a significant enhanced tendency for blood-platelet aggregation and coagulation activation in patients after DPS compared to patients after SPDP. No septic or thromboembolic events were observed in any patient. CONCLUSION Hypercoagulability in splenectomized patients persists over years. Thus, a correlation of this finding with thromboembolic events and mortality years after splenectomy should to be performed in a large cohort.
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Affiliation(s)
| | - Christin Tjaden
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Ulf Hinz
- Department of General, Visceral, and Transplantation Surgery, Germany; Division of Biostatistics, University of Heidelberg, Heidelberg, Germany
| | - Johanna Volpert
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Jens Werner
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Germany
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Lemaire J, Rosière A, Bertrand C, Bihin B, Donckier JE, Michel LA. Surgery for massive splenomegaly. BJS Open 2017; 1:11-17. [PMID: 29951600 PMCID: PMC5989945 DOI: 10.1002/bjs5.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Splenectomy for massive splenomegaly (spleen weight more than 1·5 kg) is commonly believed to be hazardous and to provide poor palliation. The aim of this cohort study was to investigate these issues and examine the many definitions of massive splenomegaly to see whether a better tool might be proposed for preoperative evaluation of these patients. METHODS Morbidity and long-term outcomes were assessed in consecutive patients. Relief of pressure-volume-related symptoms and sustainable independence from transfusion in patients were used to ascertain the impact of splenectomy. RESULTS Splenectomy was performed in 56 patients, mainly for non-Hodgkin's lymphoma and myeloproliferative diseases. Median spleen weight was 2·3 (range 1·5-6·0) kg. Mortality at 180 days was zero, and the postoperative complication rate was 25 per cent (17 complications in 14 patients). At 2 years, relief of pain was maintained in 33 of 34 patients, with sustained independence from transfusion in 15 of 19 patients with anaemia and nine of 11 with thrombocytopenia. Spleen weight correlated negatively with BMI (P = 0·036). CONCLUSION Splenectomy for massive splenomegaly is safe and provides effective palliation. Provisional cut-off points relating to spleen size and BMI help to identify patients benefiting from a splenectomy, even those in a critical state.
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Affiliation(s)
- J Lemaire
- Surgical Services Université de Louvain - Medical School at Mont-Godinne University Hospital Yvoir Belgium
| | - A Rosière
- Surgical Services Université de Louvain - Medical School at Mont-Godinne University Hospital Yvoir Belgium
| | - C Bertrand
- Surgical Services Université de Louvain - Medical School at Mont-Godinne University Hospital Yvoir Belgium
| | - B Bihin
- Biostatistics Unit Université de Louvain - Medical School at Mont-Godinne University Hospital Yvoir Belgium
| | - J E Donckier
- Internal Medicine Services Université de Louvain - Medical School at Mont-Godinne University Hospital Yvoir Belgium
| | - L A Michel
- Surgical Services Université de Louvain - Medical School at Mont-Godinne University Hospital Yvoir Belgium
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Dépistage systématique d’une thrombose veineuse splénique ou portale après splénectomie. Rev Med Interne 2017; 38:3-7. [DOI: 10.1016/j.revmed.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/03/2016] [Indexed: 01/16/2023]
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26
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Jiang GQ, Xia BL, Chen P, Qian JJ, Jin SJ, Zuo SQ, Bai DS. Anticoagulation Therapy with Warfarin Versus Low-Dose Aspirin Prevents Portal Vein Thrombosis After Laparoscopic Splenectomy and Azygoportal Disconnection. J Laparoendosc Adv Surg Tech A 2016; 26:517-23. [DOI: 10.1089/lap.2016.0012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Bing-Lan Xia
- Department of Ultrasound, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Si-Qin Zuo
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
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Resveratrol Reduces the Incidence of Portal Vein System Thrombosis after Splenectomy in a Rat Fibrosis Model. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:7453849. [PMID: 27433290 PMCID: PMC4940576 DOI: 10.1155/2016/7453849] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/07/2016] [Indexed: 01/01/2023]
Abstract
Purpose. To investigate the preventive effect of resveratrol (RES) on the formation of portal vein system thrombosis (PVST) in a rat fibrosis model. Methods. A total of 64 male SD rats, weighing 200–300 g, were divided into five groups: Sham operation, Splenectomy I, Splenectomy II, RES, and low molecular weight heparin (LMWH), with the former two groups as nonfibrosis controls. Blood samples were subjected to biochemical assays. Platelet apoptosis was measured by flow cytometry. All rats were euthanized for PVST detection one week after operation. Results. No PVST occurred in nonfibrosis controls. Compared to Splenectomy II, the incidences of PVST in RES and LMWH groups were significantly decreased (both p < 0.05). Two rats in LMWH group died before euthanasia due to intra-abdominal hemorrhage. In RES group, significant decreases in platelet aggregation, platelet radical oxygen species (ROS) production, and increase in platelet nitric oxide (NO) synthesis and platelet apoptosis were observed when compared with Splenectomy II (all p < 0.001), while in LMWH group only significant decrease in platelet aggregation was observed. Conclusion. Prophylactic application of RES could safely reduce the incidence of PVST after splenectomy in cirrhotic rat. Regulation of platelet function and induction of platelet apoptosis might be the underlying mechanisms.
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Jiang GQ, Bai DS, Chen P, Qian JJ, Jin SJ, Wang XH. Risk Factors for Portal Vein System Thrombosis After Laparoscopic Splenectomy in Cirrhotic Patients with Hypersplenism. J Laparoendosc Adv Surg Tech A 2016; 26:419-23. [PMID: 26953863 DOI: 10.1089/lap.2015.0481] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Guo-qing Jiang
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dou-sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jian-jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng-jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xue-hao Wang
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization. J Thromb Thrombolysis 2016; 40:294-301. [PMID: 25698403 DOI: 10.1007/s11239-015-1190-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cirrhosis and portal hypertension (PH) has a high incidence in China. Laparoscopic splenectomy and esophagogastric devascularization (LS + ED) was confirmed as an effective and safe surgical approach. But compared to open surgery (OS + ED), the rate of portal vein system thrombosis (PVST) was found to be higher after LS + ED. PVST is a common and potentially life-threatening complication after LS + ED in patients with cirrhosis and PH. Anti-coagulation therapy should be given early, but no standard plan for PSVT prophylaxis has been developed for all patients. In this study, the efficacy and safety of early use of low molecular weight heparin (LMWH) to prevent PVST were retrospectively evaluated compared with conventional anti-coagulant therapy. Of 219 patients with cirrhosis and PH undergoing LS + ED at our hospital from January 2008 to June 2013, 139 received early anti-coagulant therapy with LMWH, and 80 received conventional anti-coagulant therapy. The rates and types of PVST, perioperative coagulation function, intra-abdominal active bleeding, and esophagogastric variceal bleeding (EGVB) were compared in these two groups. Of the 139 patients in the early anti-coagulation group, 42 (30.2 %) experienced postoperative PVST, including two (1.4 %) with main trunk. Of the 80 patients in the conventional anti-coagulation group, 40 (50.0 %) experienced postoperative PVST, including 12 (15.0 %) with main trunk; three (3.8 %) experienced recurrent EGVB due to main trunk thrombosis, and one (1.3 %) underwent an immediate second laparotomy for uncontrollable active bleeding. The rates of postoperative PVST (P = 0.004), main trunk thrombosis (P = 0.000), and EGVB (P = 0.048) were significantly lower in the early than in the conventional anti-coagulant group, but all tested perioperative indices of coagulation function and rates of intraperitoneal active bleeding were similar. Early anti-coagulation with LMWH is safe and effective in patients with LS + ED for cirrhosis and PH.
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Rottenstreich A, Elazary R, Kalish Y. Abdominal thrombotic complications following bariatric surgery. Surg Obes Relat Dis 2016; 13:78-84. [PMID: 27444858 DOI: 10.1016/j.soard.2016.05.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/13/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thrombotic events involving the portal-splenic-mesenteric venous system (PSMVT) are rare but potentially lethal after bariatric surgery. OBJECTIVES To investigate the incidence, clinical presentation, management, and outcome of thrombotic events after bariatric surgery. SETTING Two university hospitals. METHODS A retrospective review of individuals who underwent bariatric surgery between January 2006 and December 2015. RESULTS Overall, 4386 patients underwent bariatric surgery (laparoscopic sleeve gastrectomy [LSG; n = 2886], laparoscopic Roux-en-Y gastric bypass [n = 762], laparoscopic adjustable gastric banding [n = 668], and biliopancreatic diversion [n = 70]). Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 hours after surgery until discharge) was provided for all patients. A minority of patients (n = 543, 12.4%) also received an extended course of enoxaparin for 1-4 weeks after discharge. We observed 16 cases of PSMVT, all after LSG, with an incidence of .55% (16/2886). Twelve additional patients experienced deep vein thrombosis and 6 had pulmonary embolism. Follow-up imaging indicated complete resolution in all cases, with no sequelae, recurrent thrombosis, or mortality. The overall thrombosis rate was significantly lower in patients who received an extended course of anticoagulation after LSG (P = .01) and after any type of bariatric surgery (P = .02). CONCLUSIONS PSMVT was found to occur uncommonly after LSG. Prompt diagnosis and anticoagulation therapy led to favorable outcomes in most cases. Significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation. We support its use for at least 1 week after discharge.
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Affiliation(s)
- Amihai Rottenstreich
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Jiang GQ, Bai DS, Chen P, Qian JJ, Jin SJ. Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review. JSLS 2016; 19:JSLS.2015.00091. [PMID: 26941546 PMCID: PMC4756356 DOI: 10.4293/jsls.2015.00091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objectives: Given the technical difficulty of laparoscopic splenectomy and azygoportal disconnection (LSD), data are limited that compare the laparoscopic to the open procedure. As the technique becomes more widespread, questions regarding its safety, feasibility, and reproducibility must be addressed. This review assesses the current status of LSD. Methods: We conducted our literature review with a search of the PubMed database. All published series of 5 or more laparoscopic splenectomy and azygoportal disconnection procedures were examined. The demographic, intraoperative, and postoperative data analyzed included number of ports, conversion rate, operative duration, estimated intraoperative blood loss, postoperative hospital stay, and complications. Results: Fifteen articles met the review criteria. Of 412 laparoscopic procedures, traditional laparoscopic splenectomy and azygoportal disconnection (TLSD) was used in 322 patients (78.2%), a modified laparoscopic procedure (MLSD) in 79 (19.2%), and a single-incision laparoscopic procedure (SLSD) in 11 (2.7%). Compared with the traditional and single-incision laparoscopic procedures, the MLSD procedure was associated with shorter operative duration and less blood loss. Furthermore, although the incidence of postoperative portal vein system thrombosis was higher in the laparoscopic than in the open splenectomy with azygoportal disconnection (OSD) procedure, the LSD procedure was associated with less pulmonary infection and pleural effusion and fewer incisional and overall complications than the open procedure. The rate of conversion to an open procedure was 5.4%. Conclusions: LSD is feasible and safe for selected patients when performed by an expert laparoscopic surgeon. It has perioperative advantages over OSD, but studies with longer follow-up periods and larger samples of patients are needed.
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Affiliation(s)
- Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
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Manouchehri N, Kaneva P, Séguin C, Artho GP, Feldman LS. Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy. Surg Endosc 2015; 30:2119-26. [PMID: 26307597 DOI: 10.1007/s00464-015-4476-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/28/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Portal and/or splenic vein thrombosis (PSVT) is a potentially lethal complication of splenectomy for hematologic disease. Known risk factors for PSVT include malignancy and splenomegaly. While these patients are believed to be hypercoagulable, the specific mechanism is unclear. The aim of this study is to evaluate whether specific acquired prothrombotic risk factors contribute to the development of PSVT following laparoscopic splenectomy (LS). METHODS Consecutive patients undergoing LS were prospectively studied between 2005 and 2013. Preoperatively, patients were screened for prothrombotic states and surveillance duplex ultrasonography was performed between 1 week and 1 month postoperatively to assess for PSVT. The association between baseline prothrombotic disorders and PSVT was explored using descriptive statistics. RESULTS Sixty-eight patients were included in the analysis, and 17 (25 %) of these developed PSVT. There were no differences in patients with and without PSVT with respect to age, body mass index, gender or surgical time. Preoperative spleen size, as determined by diagnostic imaging, and intraoperative blood transfusion were associated with PSVT. Seven of 9 patients (78 %) with massive splenomegaly (>20 cm) developed PSVT compared with 4 of 13 patients (31 %) with moderate splenomegaly (15-20 cm) and 6 of 45 patients (13 %) without (p < 0.001). Abnormalities in baseline prothrombotic screening tests were common, with 52 patients (75 %) demonstrating at least one; however, none were associated with the development of PSVT. CONCLUSION In patients scheduled for LS, screening for prothrombotic states is not useful to identify patients at risk of development of PSVT. Preoperative spleen size and blood transfusion were predictive of PSVT formation.
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Affiliation(s)
- Namdar Manouchehri
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada
| | - Pepa Kaneva
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada
| | - Chantal Séguin
- Department of Medicine, Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
| | - Giovanni P Artho
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada.
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Hong D, Cheng J, Wang Z, Shen G, Xie Z, Wu W, Zhang Y, Zhang Y, Liu X. Comparison of two laparoscopic splenectomy plus pericardial devascularization techniques for management of portal hypertension and hypersplenism. Surg Endosc 2015; 29:3819-26. [PMID: 25783835 DOI: 10.1007/s00464-015-4147-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 02/26/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our research was conducted to analyze the outcomes of two laparoscopic splenectomy plus pericardial devascularization (LSPD) techniques in the management of portal hypertension (PTH) and hypersplenism. METHODS Between May 2012 and May 2013, 41 patients with PTH and hypersplenism undergoing LSPD were retrospectively analyzed. Of them, 29 patients received LSPD by LigaSure Vessel Sealing System (LVSS) and Endo-GIA universal endoscopic vascular linear staplers (Endo-GIA) (EG Group) and 12 patients received LSPD by LVSS and Hem-o-Lock (HL Group). Operating time, intraoperative blood loss, postoperative course, and hospitalization costs were compared between the two LSPD combination techniques. RESULTS There were no significant differences in preoperative patient characteristics of the two groups. Significantly less operating time, intraoperative blood loss, and postoperative complications were observed in EG Group. The incidence of portal vein thrombosis was lower in the EG Group (3.4 vs. 8.3%), as well as the incidence of pancreatic fistula (0 vs. 8.3%). Upper gastrointestinal hemorrhage was not observed in either group. Uncontrolled bleeding warranted conversion to open surgery in one case in EG Group (conversion rate 3.4%) and in two cases in HL Group (conversion rate 16.7%). Two patients (16.7%) in HL Group underwent successful emergency exploratory laparotomy due to uncontrolled intraabdominal bleeding postoperatively. No re-operation was needed in EG Group. Two patients experienced liver failure after surgery in each group. Of those, three patients were managed successfully and one patient refused further therapy. While the overall complication rate was significantly lower in EG Group (17.2 vs. 58.3%, P < 0.05), overall hospitalization costs remained significantly higher for EG Group. CONCLUSION The results suggest that the modified Endo-GIA and LVSS technique is a safe and effective combination approach to LSPD with shorter operative time, less intraoperative blood loss, lower conversion rate to laparotomy, shorter hospital stay, better recovery, and lower postoperative complication rate compared with the Hem-o-Lock and LVSS approach. Higher hospitalization expenses associated with the Endo-GIA and LVSS approach.
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Affiliation(s)
- Defei Hong
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Jian Cheng
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Zhifei Wang
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Guoliang Shen
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Zhijie Xie
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Weiding Wu
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Yuhua Zhang
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Yuanbiao Zhang
- Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People's Hospital, No. 158, Shang Tang Road, Hangzhou, 310014, China.
| | - Xiaolong Liu
- Department of General Surgery, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Institute of Micro-invasive Surgery of Zhejiang University, No. 3, Qin Chun Road, Hangzhou, 310016, China.
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Zheng CL, Zhao YF, Tang Z, Wu Y, Qiao SS, Zhang SJ. Early joint application of anticoagulant drugs to prevent portal vein thrombosis after splenectomy and devascularization. Shijie Huaren Xiaohua Zazhi 2015; 23:129-133. [DOI: 10.11569/wcjd.v23.i1.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the preventive effects of early joint application of anticoagulant drugs on portal vein thrombosis after splenectomy and devascularization and to explore the possible mechanism
METHODS: One hundred and twenty-eight patients with portal hypertension who underwent splenectomy and devascularization were included, including 28 patients with early application of low molecular heparin calcium (heparin group), 42 with joint application of low molecular heparin calcium and low molecular dextran (joint group), and 58 without the use of anticoagulant drugs (control group). The rate of postoperative thrombosis, postoperative platelet count, and prothrombin time (PT) were compared among the three groups. The indexes of portal vein blood flow were also recorded.
RESULTS: One month after surgery, portal vein thrombosis developed in 5 (8.57%) cases in the heparin group, in 1 (2.38%) case in the joint group, and in 14 (24.13%) cases in the control group. The rate of postoperative portal vein thrombosis was significantly higher in the control group than in the heparin group (P < 0.05), and in the heparin group than in the joint group (P < 0.05).
CONCLUSION: Early anticoagulation use can effectively prevent the formation of portal vein thrombosis after splenectomy, and combined use of low molecular heparin calcium and low molecular dextran has better effects.
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Rottenstreich A, Khalaileh A, Elazary R. Sleeve gastrectomy and mesenteric venous thrombosis: report of 3 patients and review of the literature. Surg Obes Relat Dis 2014; 10:e57-61. [DOI: 10.1016/j.soard.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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Accessory wandering spleen: Report of a case of laparoscopic approach in an asymptomatic patient. Int J Surg Case Rep 2014; 5:887-9. [PMID: 25460427 PMCID: PMC4275829 DOI: 10.1016/j.ijscr.2014.10.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 10/12/2014] [Accepted: 10/12/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Accessory wandering spleen is a rare but dangerous condition. Abnormalities of the ligamentous apparatus of an accessory spleen may evolve into torsion of its vascular axis, which can lead to a splenic infarct making surgery necessary. Patients are often asymptomatic and the diagnosis can be accidental. An early diagnosis and a correct treatment are fundamental. PRESENTATION OF CASE In this case report a young woman underwent laparoscopic surgery after an incidental finding at a Pelvic Ultrasound of an accessory wandering spleen. DISCUSSION In literature are reported cases of asymptomatic patients with an accessory wandering spleen treated with a conservative approach. However, a torsion or infarct of the accessory wandering spleen leads to emergency surgery. The presence of an independent vascular axis of the accessory spleen reduces the risk of postoperative complications (e.g. thrombocytosis) and the administration of low molecular weight heparin should prevent the risk of portal thrombosis. CONCLUSION We suggest performing surgery with a laparoscopic approach in patients with accessory wandering spleen, though asymptomatic, because of the risk of serious complications in case of accessory spleen torsion.
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Kakisaka T, Kamiyama T, Yokoo H, Orimo T, Wakayama K, Tsuruga Y, Kamachi H, Harada T, Kato F, Yamada Y, Mitsuhashi T, Taketomi A. Hand-assisted laparoscopic splenectomy for sclerosing angiomatoid nodular transformation of the spleen complicated by chronic disseminated intravascular coagulation: a case report. Asian J Endosc Surg 2014; 7:275-278. [PMID: 25131328 DOI: 10.1111/ases.12116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/22/2014] [Accepted: 04/30/2014] [Indexed: 02/05/2023]
Abstract
A 36-year-old man who presented with a nosebleed and anemia was referred to our hospital. Laboratory test results showed platelet depletion, decreased levels of fibrinogen, and increased fibrinogen degeneration products. CT showed a 13-cm splenic tumor. T2 -weighted MRI revealed a high-intensity mass. We preoperatively diagnosed splenic hemangioma with chronic disseminated intravascular coagulation and scheduled an operation to relieve the disseminated intravascular coagulation. We also performed hand-assisted laparoscopic splenectomy to ensure easy handling of the splenomegaly. The resected specimen microscopically consisted of hemorrhages and hemangiomatous lesions, and multiple angiomatoid nodules were scattered and separated by fibrocollagenous stroma with inflammatory cells. Three types of vessels (capillaries, sinusoids and small veins) were contained in the angiomatoid nodules, and the pathological diagnosis was sclerosing angiomatoid nodular transformation. The results of this case suggest that we should consider sclerosing angiomatoid nodular transformation in the differential diagnosis of patients with splenic tumors, as sclerosing angiomatoid nodular transformation with hemangiomatous features may cause coagulation disorders for which splenectomy should be performed.
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Affiliation(s)
- Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Casaccia M, Stabilini C, Gianetta E, Ibatici A, Santori G. Current concepts of laparoscopic splenectomy in elective patients. World J Surg Proced 2014; 4:33-47. [DOI: 10.5412/wjsp.v4.i2.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/13/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Formerly, open splenectomy represented the conventional surgical treatment for many hematologic diseases. Currently, thanks to permanent technical development and improved skills, also laparoscopic splenectomy (LS) has become a recognized procedure in the treatment of spleen diseases, even in case of splenomegaly. A systematic review was performed with the aim of recalling the proved concepts of this surgical treatment and to browse new devices and techniques and their impact on the surgical outcome. The literature search was initially conducted in PubMed by entering general queries related to LS. The record identified through PubMed searching (n = 1599) was then screened by applying several criteria (study published in English from 1991 to 2013 with abstract available, by excluding systematic/non-systematic reviews, meta-analysis, practice guidelines, case reports, and study involving animals). The articles assessed for eligibility (n = 160) were primarily evaluated by excluding studies that did not report operative time and conversion to open surgery. For articles that treated multiport LS we included only clinical trials with patients > 20. The studies included in qualitative synthesis were 23. The search strategy carried out in PubMed does not allow to obtain an overview of the items returned by the main queries. With this aim we replicated the search in the Web of ScienceTM database, only including the studies published in English in the period 1991-2013 with no other filter/selection criteria. The full records (n = 1141) and cited references returned by Web of ScienceTM were analyzed with the visualization of similarities (VOS) mapping technique. Maps of title/abstract text corpus and bibliographic coupling of authors obtained by applying the VOS approach were presented. If in normal-size or moderately enlarged spleens the laparoscopic approach is unquestionable, in massive splenomegaly the optimal technique remain to be determined. In this setting, prospective randomized trials to compare open vs LS are needed. Between the new techniques of LS the robotic single port splenectomy has the ability to join all the positive aspects of both techniques. Data about this topic are too initial and need to be confirmed with further studies.
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Cheng Z, Li JW, Chen J, Fan YD, Guo P, Zheng SG. Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases. J Laparoendosc Adv Surg Tech A 2014; 24:612-6. [PMID: 24960036 DOI: 10.1089/lap.2014.0036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate the effects and technical points of laparoscopic splenectomy and esophagogastric devascularization (LS+ED) for portal hypertension (PH) due to liver cirrhosis. SUBJECTS AND METHODS In total, 204 PH patients who underwent LS+ED from January 2008 to April 2013 in the Southwest Hospital of the Third Military Medical University were enrolled in this study. We retrospectively analyzed the clinical data and the key technical points and compared the results with other researchers. RESULTS LS+ED was successfully carried out on 188 patients. The mean duration of surgery was 232±59 minutes, the mean intraoperative blood loss was 189±137 mL, the rate of blood transfusion was 19.6% (40/204), and no deaths occurred during surgery. The mean postoperative interval to passing of flatus was 3.5±0.9 days, and the mean postoperative hospital stay was 8.7±2.2 days. Operative complications occurred in 100 patients, of whom 78 had portal vein system thrombosis (PVST). During a postoperative follow-up period of 2-65 months, 15 cases were lost to follow-up, esophagogastric variceal bleeding re-occurred in 7 patients, encephalopathy occurred in 2 patients, and secondary liver cancer occurred in 3 patients. Five patients died during this period. CONCLUSIONS The technical points of LS+ED include a combined surgical approach, a reasonable surgical procedure, and an appropriate laparoscopic operating plane. LS+ED is a safe and effective treatment for minimal trauma and rapid recovery. PVST is a common and potentially life-threatening complication after LS+ED, and anticoagulation therapy should be given early.
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Affiliation(s)
- Zhe Cheng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University , Shapingba District, Chongqing, China
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Michel M. Warm autoimmune hemolytic anemia: Advances in pathophysiology and treatment. Presse Med 2014; 43:e97-e104. [DOI: 10.1016/j.lpm.2014.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022] Open
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Li MX, Zhang XF, Liu ZW, Lv Y. Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis. Hepatobiliary Pancreat Dis Int 2013; 12:512-519. [PMID: 24103282 DOI: 10.1016/s1499-3872(13)60081-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis. Prevention and timely detection of PVT are quite significant. There is a lack of knowledge about the clinical features and risk factors of PVT. Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals. METHODS We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution. Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared. Univariate and multivariate analyses of risk factors of PVT were performed. The mortality and rebleeding rate of the patients were also evaluated. RESULTS Of the 472 patients, 52 were excluded from the study. PVT developed in 71 (71/420, 16.9%) patients. Multivariate analysis revealed that wider preoperative portal vein diameter, postoperative thrombocytosis, prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio (OR): 5.701, 2.807, 1.850 and 2.090, respectively]. The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not. Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant. Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group (P=0.044). CONCLUSIONS Wider preoperative portal vein diameter, postoperative thrombocytosis, prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT. PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival.
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Affiliation(s)
- Mu-Xing Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710061, China.
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Sekhar M, McVinnie K, Burroughs AK. Splanchnic vein thrombosis in myeloproliferative neoplasms. Br J Haematol 2013; 162:730-47. [PMID: 23855810 DOI: 10.1111/bjh.12461] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Splanchnic vein thrombosis (SVT) is one of the most important complications of myeloproliferative neoplasms (MPN). Although MPN are common causes of SVT, the pathophysiological mechanisms underlying this predisposition, their epidemiology and natural history are not fully understood. Studies have concentrated on the generalized prothrombotic environment generated by MPN and their relationship with abnormal blood counts, thereby furthering our knowledge of arterial and venous thrombosis in this population. In contrast, there are few studies that have specifically addressed SVT in the context of MPN. Recent research has demonstrated in patients with MPN the existence of factors increasing the risk of SVT such as the presence of the JAK2 V617F mutation and its 46/1 haplotype. Features unique to the circulating blood cells, splanchnic vasculature and surrounding micro-environment in patients with MPN have been described. There are also abnormalities in local haemodynamics, haemostatic molecules, the spleen, and splanchnic endothelial and endothelial progenitor cells. This review considers these important advances and discusses the contribution of individual anomalies that lead to the development of SVT in both the pre-neoplastic and overt stage of MPN. Clinical issues relating to epidemiology, recurrence and survival in these patients have also been reviewed and their results discussed.
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Affiliation(s)
- Mallika Sekhar
- Department of Haematology, Royal Free Hospital, London, UK
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Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study. J Gastrointest Surg 2013; 17:654-9. [PMID: 23358846 DOI: 10.1007/s11605-013-2150-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 01/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization are still uncertain. The aim of this study was to compare our results for laparoscopic splenectomy and esophagogastric devascularization with those for open splenectomy and esophagogastric devascularization. MATERIALS AND METHODS From January 2008 to December 2011, 153 patients were diagnosed with portal hypertension and serious gastroesophageal varices in our institute, among which, 107 patients also had repeated upper gastrointestinal bleeding and 85 had severe hypersplenism. Eighty patients chose laparoscopic splenectomy and esophagogastric devascularization and 73 patients underwent the open procedure. Results and outcomes were compared retrospectively. RESULTS Nine patients underwent conversion to laparotomy in the laparoscopic group. We compared the laparoscopic group (80 patients) and the open group (73 patients). Operating times and the frequencies of blood transfusions were similar. Blood loss was less (P = 0.044), the passing of flatus was earlier (P = 0.041), and hospital stays were shorter (P = 0.028) in the laparoscopic group. Portal vein system thrombosis after laparoscopy was more frequent (P = 0.012) but the rates of main trunk occlusion were similar between the two groups. Pleural effusion after laparoscopy was less (P = 0.021) and, apart from this, there was no difference in other morbidities between the two groups. During a postoperative follow-up period of 2 to 50 months in 80 patients of the laparoscopic group vs. 73 patients of the open group, the incidence of esophagogastric variceal rebleeding, encephalopathy, and secondary liver cancer showed no significant differences. And the mortality rates for each of the groups were not different. CONCLUSIONS The short-term effects of laparoscopic splenectomy and esophagogastric devascularization were better than those for open surgery, and the medium-term effects were similar between these two surgical approaches. Prospective randomized studies with a greater number of cases are needed to confirm the role of laparoscopy in splenectomy and esophagogastric devascularization.
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Alexakis N, Dardamanis D, Albanopoulos K, Ptohis N, Skalistira M, Karagiorga M, Zografos G, Leandros E. Incidence, Risk Factors, and Outcome of Portal Vein Thrombosis After Laparoscopic-Assisted Splenectomy in β-Thalassemia Patients: A Prospective Exploratory Study. J Laparoendosc Adv Surg Tech A 2013; 23:123-8. [DOI: 10.1089/lap.2012.0268] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicholas Alexakis
- Department of Surgery, University of Athens, Hippocratio Hospital, Athens, Greece
| | - Dimitrios Dardamanis
- Department of Surgery, University of Athens, Hippocratio Hospital, Athens, Greece
| | | | - Nikolaos Ptohis
- Department of Radiology, Gennimatas Hospital, Athens, Greece
| | - Maria Skalistira
- Department of Anesthesiology, Hippocratio Hospital, Athens, Greece
| | | | - George Zografos
- Department of Surgery, University of Athens, Hippocratio Hospital, Athens, Greece
| | - Emmanuel Leandros
- Department of Surgery, University of Athens, Hippocratio Hospital, Athens, Greece
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Kakinoki K, Okano K, Suto H, Oshima M, Hagiike M, Usuki H, Deguchi A, Masaki T, Suzuki Y. Hand-assisted laparoscopic splenectomy for thrombocytopenia in patients with cirrhosis. Surg Today 2012; 43:883-8. [PMID: 23143171 DOI: 10.1007/s00595-012-0413-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/07/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Although splenectomy plays an important role in the management of patients with liver cirrhosis, the optimal technique, open surgery, total laparoscopic surgery or hand-assisted laparoscopic surgery (HALS), has not yet been defined. The present study evaluated the outcomes of HALS splenectomy for cirrhotic patients. METHODS A total of 28 consecutive patients with cirrhosis that underwent HALS splenectomy were enrolled into this study. The preoperative laboratory and morphometric data, intraoperative variables and postoperative outcomes were reviewed from the hospital charts. RESULTS The postoperative platelet count was remarkably elevated in all cases. A re-operation was required in 1 patient complicated with postoperative hemorrhage. Enhanced CT on POD 7 revealed a high incidence of portal or splenic vein thrombosis (PSVT; 22 patients, 78.6 %). PSVT was significantly associated with higher serum bilirubin, higher indocyanine green retention value at 15 min (ICG R-15), and larger splenic vein diameter. CONCLUSION HALS splenectomy was a very feasible and appropriate procedure for cirrhotic patients with hypersplenism. PSVT was a frequent complication and large splenic vein diameter, high serum bilirubin, and high ICG R-15 were found to be significant risk factors for PSVT after HALS splenectomy in cirrhotic patients.
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Affiliation(s)
- Keitaro Kakinoki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kida-gun, Kagawa, 761-0793, Japan.
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Hyodo M, Sata N, Koizumi M, Sakuma Y, Kurihara K, Lefor AT, Ohki J, Nagai H, Yasuda Y. Laparoscopic splenectomy using pneumoperitoneum or gasless abdominal wall lifting: a 15-year single institution experience. Asian J Endosc Surg 2012; 5:63-8. [PMID: 22776366 DOI: 10.1111/j.1758-5910.2011.00124.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/03/2011] [Accepted: 11/11/2011] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Laparoscopic splenectomy using pneumoperitoneum has been performed since 1992. The gasless abdominal wall-lifting method for laparoscopic splenectomy was introduced as an alternative. This retrospective study was undertaken to compare results using the two techniques. METHODS Between 1995 and 2010, 54 patients underwent laparoscopic splenectomy at a single institution; 30 underwent the procedure using the gasless technique and 24 using pneumoperitoneum. There were no significant differences between the two groups regarding age, sex or BMI, but more patients underwent concurrent operations in the pneumoperitoneum group. The abdominal wall-lift system with subcutaneous K-wires was used for the gasless method. RESULTS Intraoperative blood loss was similar in the two groups (193.0 ± 196.7 mL gasless, 217.3 ± 296.6 mL pneumoperitoneum; P > 0.05), but operative time (182.1 ± 92.1 min, 135.1 ± 46.1 min; P < 0.05), and resected spleen weight (306.1 ± 297.7 g, 138 ± 81.0 g; P < 0.05) were significantly different. In the gasless group, additional procedures included conversion (n = 1), mini-laparotomy (n = 2), and CO(2) insufflation (n = 2). Excluding the concurrent living-related kidney donor patients, hospital stay was similar (6.9 ± 2.5 days, 6.3 ± 2.0 days, P > 0.05). CONCLUSION Although gasless laparoscopic splenectomy is feasible, there are disadvantages, particularly the restricted operative working space in some patients. These results suggest that either technique may be used on an individual basis in patients undergoing laparoscopic splenectomy.
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Affiliation(s)
- M Hyodo
- Department of Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan.
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Bekheit M, Katri KM, Ezzat T. Wandering hemi-spleen: Laparoscopic management of wandering spleen in a case of polysplenia. Int J Surg Case Rep 2012; 3:151-154. [PMID: 22382032 PMCID: PMC3312059 DOI: 10.1016/j.ijscr.2011.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Several congenital anomalies of the spleen have been reported. The polysplenia is a rare anomaly in which the normal spleen is replaced with two or more smaller spleens. The wandering spleen is another anomaly resulting from the laxity of the splenic ligaments. The concomitance of both anomalies is very rare. PRESENTATION OF A CASE A 22-year old female patient presented with intermittent left hypochondrial pain for more than a year. After a thorough examination of the patient, she only had bilateral accessory nipples. Routine laboratory investigations were all normal. An abdominal ultrasound U/S scan was unremarkable except for a ptotic spleen. with a large splenule 5cm×3cm located near the fundus of the stomach. These findings were confirmed by a CT scan. A decision for a surgical intervention was then made, and the laparoscopic approach was chosen which revealed the condition. Laparoscopic removal of the wandering part was executed. The patient discharged on the first post-operative day. DISCUSSION The decision making in cases of wandering spleen is not always the same. The association of a wandering spleen with polysplenia is an asset to the surgical decision, along with the age of the patient. CONCLUSION The laparoscopic approach is an important tool in the diagnosis and management of wandering spleen. The diagnosis of polysplenic anomaly could provide a guidance for the surgical strategy in patients with wandering spleen.
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Affiliation(s)
| | | | - Tarek Ezzat
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
- Endocrine Surgery Unit, Royal Free Hospital, UCL, London, UK
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Wang H, Kopac D, Brisebois R, Sample C, Shapiro AMJ. Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy. Can J Surg 2011; 54:227-31. [PMID: 21443837 DOI: 10.1503/cjs.049909] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Splenic and portal vein thrombosis (SPVT) is a potentially life-threatening complication of splenectomy. There is a paucity of studies examining the role of prophylactic pre- and postoperative anticoagulation in the prevention of this complication. We designed a prospective randomized controlled trial (RCT) to more rigorously address the impact of prophylactic anticoagulation on the incidence of asymptomatic or symptomatic SPVT, detected on Doppler ultrasound, after laparoscopic splenectomy. METHODS This 2-centre, phase II, prospective, open-label, parallel-assignment RCT compared no postoperative anticoagulation to a regimen of 40 mg of enoxaparin subcutaneously once daily for 21 days. All patients underwent Doppler ultrasonography of the splenoportal system preoperatively and again 14-28 days after surgery to screen for nonocclusive or occlusive thrombosis. RESULTS From November 2006 to November 2008, 35 patients were enrolled in the RCT. Four patients withdrew, 1 required conversion to an open procedure and 1 died at 3 months (the cause of death was not related to the study). Of the 29 patients remaining, 15 were randomly assigned to the anticoagulation group and 14 to the nonanticoagulation group. One (3.4%) patient in the treatment group experienced portal thrombosis. Rates of postoperative bleeding were similar in both groups. CONCLUSION This RCT of anticoagulation found a low overall risk of SPVT after laparoscopic splenectomy; however, this is an underpowered study, and further multicentred clinical trials are needed.
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Affiliation(s)
- Haili Wang
- The Department of Surgery at the University of Alberta Hospital, Edmonton, Alta
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Affiliation(s)
- Ku Yong Chung
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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Swanson TW, Meneghetti AT, Sampath S, Connors JM, Panton ONM. Hand-assisted laparoscopic splenectomy versus open splenectomy for massive splenomegaly: 20-year experience at a Canadian centre. Can J Surg 2011; 54:189-93. [PMID: 21443834 DOI: 10.1503/cjs.044109] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multiple techniques for splenectomy are now employed and include open, laparoscopic and hand-assisted laparoscopic splenectomy (HALS). Concerns regarding a purely laparoscopic splenectomy for massive splenomegaly (> 20 cm) arise from potentially longer operative times, higher conversion rates and increased blood loss. The HALS technique offers the potential advantages of laparoscopy, with the added safety of having the surgeon's hand in the abdomen during the operation. In this study, we compared the HALS technique to standard open splenectomy for the management of massive splenomegaly. METHODS We reviewed all splenectomies performed at 5 hospitals in the greater Vancouver area between 1988 and 2007 for multiple demographic and outcome measures. Open splenectomies were compared with HALS procedures for spleens larger than 20 cm. Splenectomy reports without data on spleen size were excluded from the analysis. We performed Student t tests and Pearson χ(2) statistical analyses. RESULTS A total of 217 splenectomies were analyzed. Of these, 39 splenectomies were performed for spleens larger than 20 cm. We compared the open splenectomy group (19 patients) with the HALS group (20 patients). There was a 5% conversion rate in the HALS group. Estimated blood loss (375 mL v. 935 mL, p = 0.08) and the mean (and standard deviation [SD]) transfusion rates (0.0 [SD 0.0] units v. 0.8 [SD 1.7] units, p = 0.06) were lower in the HALS group. Length of stay in hospital was significantly shorter in the HALS group (4.2 v. 8.9 d, p = 0.001). Complication rates were similar in both groups. CONCLUSION Hand-assisted laparoscopic splenectomy is a safe and effective technique for the management of spleens larger than 20 cm. The technique results in shorter hospital stays, and it is a good alternative to open splenectomy when treating patients with massive splenomegaly.
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Affiliation(s)
- Todd W Swanson
- Department of Surgery, University of British Columbia, Vancouver, Canada.
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