A New Strategy of Laparoscopic Splenectomy for Cirrhotic Patients with Hypersplenism

Jota Watanabe, MD, Fumiki Kushihata, MD, Masahide Hatano, MD, Hitoshi Inoue, MD, Yoshikuni Yonenaga, MD, Akifumi Miyoshi, MD, Taiji Tohyama, MD, Kazuo Honda, MD, Yasutsugu Takada, MD. Department of Hepat-Biliary-Pancreatic Surgery and Transplantation, Ehime university college of Medicine

Background: Laparoscopic procedure has become the standard approach for most of splenectomy cases, but laparoscopic splenectomy (LS) for cirrhotic patients with hypersplenism still remain controversial. We report a new strategy of LS for cirrhotic patients with hypersplenism.
Methods: In case of liver cirrhosis and portal hypertension, splenectomy has been performed either for 1) bleeding tendency due to thrombocytopenia, 2) before the induction of interferon therapy for hepatitis virus infection, 3) to improve thrombocytopenia undergoing anticancer therapy of hepatocellular carcinoma (HCC), 4) to improve the portal hypertension, 5) standby for liver transplantation. From December 2008 to December 2010, 10 cirrhotic patients with hypersplenism underwent LS. All the patients were Child-Pugh class A or B. A preoperative multi-detector-row computed tomography scan was performed for each patient to assess spleen size and the development of collateral vessels surrounding the spleen.
Results: All patients had no severe complications and without a platelet-rich plasma transfusion. Conversion to open surgery was necessary for one patient (10%) because of hemorrhage. The mean weight of spleen was 520g, which was megalosplenia than that of reported ever. The preoperative platelet count (a mean of 3.6 x 104 /mm2) was significantly elevated one month after LS (a mean of 17.2 x 104 /mm2). We present some typical cases.
Conclusion: LS for liver cirrhosis and portal hypertension becomes a feasible and safe approach with precise preoperative anatomical assessment and refined laparoscopic technique. Our new strategy of LS is a novel step of multidisciplinary therapy for HCC and chronic hepatitis with hypersplenism. Application of LS to cirrhotic patients with hypersplenism will increase in future.

Session: Emerging Technology Poster
Program Number: ETP039
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