Thrombosis in the portal venous system after elective laparoscopic splenectomy.
BACKGROUND
The occurrence of thrombosis in the portal system is an underappreciated complication of splenectomy. Presenting symptoms are usually mild and nonspecific. The short hospital stay associated with the laparoscopic approach could delay the early diagnosis of this condition unless routine imaging controls are planned after discharge.


METHODS
The records of 40 patients who underwent laparoscopic splenectomy at our institution were reviewed for clinical signs of thrombosis in the portal system and associated factors. All patients were also enrolled in a color Doppler ultrasound surveillance program.


RESULTS
Nine patients (22.5%) developed thrombosis of the splenic vein, progressing to the portal vein in five cases (12.5%). Six patients (15%) were symptomatic. Thrombosis occurred even as late as 4 months after splenectomy. Spleen weight was the only significant factor predictive of postoperative thrombosis. The combination of splenomegaly and an elevated preoperative platelet count was associated with a 75% incidence of this complication.


CONCLUSIONS
The high risk of thrombosis after the laparoscopic resection of large spleens should prompt strict postoperative imaging surveillance, combined with a more aggressive anticoagulation prophylaxis.
Pietrabissa
A
A
Division of General and Transplantation Surgery, Department of Oncology, Transplantation, and Advanced Technologies in Medicine, University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56124, Pisa, Italy. apietrab@med.unipi.it
Moretto
C
C
Antonelli
G
G
Morelli
L
L
Marciano
E
E
Mosca
F
F
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010976:Platelet Count; D011169:Portal Vein / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D013156:Splenectomy / Q000379:methods / Q000706:statistics & numerical data*; D013162:Splenic Vein / Q000000981:diagnostic imaging; D013163:Splenomegaly / Q000150:complications / Q000601:surgery; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants