Laparoscopic splenectomy versus partial splenic embolization for the management of hypersplenism in cirrhotic patients

Zhong Wu, PhD, Jin Zhou, PhD, Bing Peng, PhD

West China Hospital, Sichuan University

Introduction: Our study was conducted to assess the clinical safety and efficacy and long-term follow up of open splenectomy (OS) and laparoscopic splenectomy (LS) compared to partial splenic embolization (PSE) in the management of hypersplenism in cirrhotic patients.

Methods and procedures: This study was comprised of 147 patients with hypersplenism secondary to cirrhosis. Of the 147 patients, 51 underwent PSE, 46 underwent LS and 50 were treated by OS. In the PSE group, the mean embolization infarction was 46.3%. We reviewed the surgical method and the peri- and postoperative as well as follow-up outcomes. Responses to surgery were categorized as complete response (CR), defined as a platelet count ≥100×109/L and partial response (PR), defined as a platelet count 50-99×109/L. The follow-up period ranged from 4 to 40 months (mean 21 months).

Results: No significant difference in preoperative demographics was found among the three groups, including age, gender distribution and Child-Pugh class. Intraoperatively, the mean operating time significantly increased from the PSE group (20.6 min) to the OS group (176.3 min) and LS group (198.5 min). Intraoperative blood loss sharply decreased from the OS group (410 ml) to the LS group (137.6 ml) to the PSE group (23 ml). Sixteen and ten patients from the OS and LS groups, respectively, received an intraoperative transfusion, while no patients from the PSE group received intraoperative transfusions. The mean postoperative hospital stay was 5.2 days in the PSE group, 7.3 days in the LS group and 9.5 days in the OS group. There were no perioperative (30 days) deaths in the LS and OS groups. Two patients died in the PSE group 5 days after surgery, due to bleeding and infective endocarditis and aortic valve perforation. The PSE group had a higher rate of postoperative complications (30 of 51, 59%) compared with the LS (8 of 46, 17%) and OS groups (15 of 50, 30%). All patients in the PSE group had problems related to postembolization syndrome that abated by the first week. Asymptomatic portal vein thrombosis developed in 3 patients in the PSE group, 2 in the LS group and one in the OS group. They were all treated with conservative therapy with good outcomes. During the follow up, 37 of 51 patients from the PSE group had a complete or partial clinical response (CR n=7, PR n=30), while all patients from the LS (CR n=45, PR n=1) and OS groups (CR n=47, PR n=3) had a complete or partial clinical response. The comparison between pre- and post-operative hematological parameters and liver function variables showed favorable improvement in all of the groups. The patients from the LS and OS groups had better results in hematological parameters and liver function variables than the PSE group during the follow up period.

Conclusions: LS is a long-term, effective therapeutic modality for the treatment of hypersplenism secondary to chronic liver disease, with fewer complications compared to OS and PSE.

Session: Poster Presentation

Program Number: P496

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