title: Laparoscopic splenectomy for portal hypertension.
abstract: OBJECTIVE
  Laparoscopic splenectomy is now increasingly being performed. However, controversy remains regarding the effectiveness of a laparoscopic splenectomy for patients with portal hypertension.
  
  
  METHODS
  Seventy-three patients with portal hypertension who underwent a laparoscopic splenectomy from February 1992 until October 2000 were reviewed and the effectiveness of the procedures for portal hypertension was evaluated. Forty-two patients had esophagogastric varices and twenty had a concomitant hepatocellular carcinoma. The indications for surgery were bleeding tendency due to thrombocytopenia (n = 40), difficulty in receiving treatment for hepatocellular carcinoma due to thrombocytopenia (n = 18), and sclerotherapy-resistant esophagogastric varices (n = 15).
  
  
  RESULTS
  A laparoscopic splenectomy was successfully performed in all the patients. The rate of conversion to conventional open surgery was 9.6% (7/73). The mean operative time was 210.1 +/- 101.9 minutes, and the estimated blood loss was 374.7 +/- 352.4 mL. There were no cases of mortality, and morbidity was encountered in 11.0% of patients. The increase in the platelet count correlated significantly to the spleen weight (P < 0.001). The platelet count had been maintained at over 10 x 10(4)/mm3 for over three years. Eighteen patients with hepatocellular carcinoma successfully underwent treatment for hepatocellular carcinoma after surgery and no recurrence of esophagogastric varices was encountered.
  
  
  CONCLUSIONS
  A laparoscopic splenectomy resulted in the successful secondary treatment of hepatocellular carcinoma and esophagogastric varices. Portal hypertension was not a contraindication. A laparoscopic approach is therefore the procedure of choice for a splenectomy in portal hypertension.
authors.affiliation: Departments of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. mhashi@dem.med.kyushu-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tanoue
authors.forename: Norikazu
authors.initials: N
authors.lastname: Gotoh
authors.forename: Kozo
authors.initials: K
authors.lastname: Konishi
authors.forename: Keishi
authors.initials: K
authors.lastname: Okita
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.forename: Rinshun
authors.initials: R
authors.lastname: Shimabukuro
authors.forename: Shohei
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Keizo
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*