Recommended Timing for Surveillance Ultrasonagraphy to Diagnose Portal Vein Thrombosis After Laparoscopic Splenectomy

Introduction: Symptomatic portal or splenic vein thrombosis (PSVT) is a rare but potentially lethal complication of laparoscopic splenectomy (LS). Routine postoperative duplex ultrasound surveillance of asymptomatic patients can be used for early detection. The optimal timing for surveillance ultrasonography is unknown. The aim of this study was to estimate the incidence and progression of asymptomatic PSVT one week and one month after LS.
Methods: Consecutive patients scheduled for LS for hematologic disease participated in this ethics committee approved study. At baseline, ultrasound or CT scan was performed and demographic and laboratory data were collected. Patients received perioperative DVT prophylaxis and underwent surveillance for PSVT using duplex ultrasonography including spectral and color Doppler B-mode technique 1 week and 1 month postop. Treatment with low molecular weight heparin and warfarin was initiated once the diagnosis was established and continued for 3-6 months. Data are reported as median (IQR) or percent.
Results: 38 of 39 patients undergoing LS in the study period enrolled in the study, with 2 subsequently excluded (one did not undergo LS due to carcinomatosis and one developed extensive lower extremity DVT and did not return for abdominal imaging), leaving 36 patients for analysis. The indications for LS were benign disease in 27 (16 had ITP) and malignant disease in 9. Hand assist technique was used for the 5 spleens >17cm in length. OR time was 120.5 (89.5-185) minutes and postop length of stay was 2 (1-3) days. PSVT was diagnosed in 7/36 patients (19.4%). 6 (16.7%) were diagnosed by 1 week, of whom one was symptomatic (fever and diarrhea). After anticoagulation, subsequent ultrasounds showed resolution or improvement in all 6 patients. 30 patients had a normal ultrasound result at 1 week. Of 27 patients who had follow-up ultrasound at 1 month, only 1/27 (3.7%) revealed a new PSVT. This patient did not return for follow-up until 6 months postop, and ultrasound then showed complete resolution without treatment.
Conclusions: The one-month incidence of PSVT after laparoscopic splenectomy was 19.4%. The high incidence justifies screening on postoperative day 7. If asymptomatic PSVT has not developed at this time, it is unlikely to develop by one month, and a subsequent screening ultrasound is not required.

Session: Podium Presentation

Program Number: S068

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