Long-term Post-operative Results of Laparoscopic and Open Splenectomy Due to Hypersplenism Secondary to Liver Cirrhosis

Jin Zhou, PhD, Zhong Wu, MD, Bing Peng, PhD. West China Hospital, Sichuan University

Abstract
Background: Hypersplenism is a common clinical manifestation encountered in patients with liver cirrhosis. For treatment, surgeons can choose between an open or laparoscopic approach. Although splenectomies are gaining increasing importance in patients with hypersplenism secondary to liver cirrhosis, there are limited data with regards to their long-term outcomes, including hematological response and liver function. This study was performed to investigate the long-term effect of open and laparoscopic splenectomy for cirrhotic patients with hypersplenism.
Methods: Between September 2003 and June 2011, 63 consecutive patients with hypersplenism secondary to liver cirrhosis who were treated with laparoscopic splenectomy (n=34) or open splenectomy (n=29) were enrolled in the study. The hematological parameters and liver function in both groups were assessed before and after splenectomy during a long-term follow-up period.
Results: Post-operatively, 100% patients in both groups had a complete response in platelet and leukocyte counts. No changes in liver function were noted. The LS group benefitted from shorter operative time, less intraoperative blood loss, less scarring and a shorter post-operative hospital stay than the OS group. The median follow-up period was 25 months. All patients were still alive at the last follow-up visit. All patients showed complete or partial hematological response to splenectomy and had an improvement in liver function. None of the parameters were significantly different between the two groups. Portal or splenic vein thrombosis was detected in 3 patients, while esophageal variceal bleeding occurred in 2 patients.
Conclusion: In patients with hypersplenism secondary to liver cirrhosis, splenectomy is an effective and safe treatment that can improve hematological response and liver function. Thus, LS can be considered a favorable surgical procedure that has good surgical outcomes compared to OS.
 

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