Impact of Surgical Technique and Splenic Size On Post-operative Mesenteric Vein Thrombosis

Ivanesa Pardo, MD, Rahul Reddy, MD, Eric Wiebke, MD, Don Selzer, MD. Indiana University School of Medicine

Introduction: Portal vein thrombosis (PVT) is a well documented complication after splenectomy. The incidence of PVT in symptomatic patients has been reported to be up to 15 % and up to 50% in asymptomatic patients through postoperative radiographic surveillance. Ikeda demonstrated PVT to be more common in the laparoscopic approach when compared to the open approach (55% vs. 19% respectively). Risk factors for PVT include splenomegaly, malignancy and hypercoagulable disorders. Hand assisted laparoscopic splenectomy (HALS) is a newer technique that allows the removal of large spleens while maintaining the advantages of laparoscopic surgery. The aim of this study is to compare the incidence of PVT in small vs. large spleens between the different surgical techniques (open, laparoscopic and HALS).
Methods: A retrospective review of 119 patients who underwent splenectomy for hematological disorders in a period of 9 years was performed. Seventy two patients underwent open splenectomy (OS), 30 underwent HALS and 17 underwent laparoscopic splenectomy (LS). Six patients were converted from LS to OS; no conversions from HALS were encountered. Large spleens were defined to be > 1000 gm. PVT was diagnosed by postoperative contrasted helical CT scan. Statistical analysis was performed using the SPSS 19.0 software.
Results: PVT was diagnosed in 6 patients (OS: 2, LS: 1, HALS: 3). There were no differences in age, gender, platelet counts, estimated blood loss, and type of procedure. Statistical differences were encountered for both spleen size groups in length of stay between HALS and OS (p: 0.001) but not between LS and OS (p: 0.055); also time to oral intake was statistically different between HALS and OS (p: 0.001) but not between LS and OS (p: 0.447). Multivariate logistic regression confirmed PVT was dependent on splenic size rather than surgical technique.
Conclusions: There is no difference in the incidence of PVT between laparoscopic, HALS and open splenectomy. The incidence of PVT is higher in large spleens. HALS allows the removal of large spleens and maintains the benefits of laparoscopic surgery such as shorter length of stay and shorter time to oral intake.