Laparoscopic splenectomy for portal hypertension.
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.
Hashizume
Makoto
M
Departments of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. mhashi@dem.med.kyushu-u.ac.jp
Tomikawa
Morimasa
M
Akahoshi
Tomohiko
T
Tanoue
Kazuo
K
Gotoh
Norikazu
N
Konishi
Kozo
K
Okita
Keishi
K
Tsutsumi
Norifumi
N
Shimabukuro
Rinshun
R
Yamaguchi
Shohei
S
Sugimachi
Keizo
K
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*