title: Significance of laparoscopic splenectomy in patients with hypersplenism.
abstract: OBJECTIVE
  This study was aimed at investigating the efficacy and safety of minimally invasive laparoscopic splenectomy in patients with hypersplenism secondary to cirrhosis.
  
  
  BACKGROUND
  While advances have been made in the treatment of liver cancer and chronic hepatitis, certain treatments such as radio frequency ablation (RFA) must often be discontinued due to thrombocytopenia caused by hypersplenism. Laparoscopic splenectomy is performed to treat diseases as idiopathic thrombocytopenic purpura, but is contraindicated for hypersplenism in many institutions. Few studies have thus examined the safety and efficacy of this approach.
  
  
  METHODS
  Efficacy and safety were retrospectively analyzed for laparoscopic splenectomies starting from January 2003. Relationships between postoperative increases in platelet count and thrombopoietin, platelet-associated immunoglobulin, excised spleen weight, and serum parameters were examined. Perioperative data of open splenectomies starting from January 1990 were compared with those of laparoscopic splenectomies.
  
  
  RESULTS
  No laparoscopic cases were converted to open surgery in this series. Mean operative times of open and laparoscopic splenectomy were 205 and 173 min respectively. Mean blood losses were 750 and 359 ml (P < 0.05) and the mean weights of excised spleen were 460 and 525 g respectively. Postoperatively, no changes in liver function were noted, and platelet and leukocyte counts were significantly increased. Compared with preoperative platelet count, degree of increase at 2 weeks postoperatively did not correlate with preoperative thrombopoietin levels, but significantly correlated with levels of platelet-associated immunoglobulin and spleen volume (P < 0.05). Postoperative portal or splenic vein thrombosis (PSVT) was seen in 3 patients and these patients did not exhibit any clinical symptoms.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy is a safe technique for the treatment of hypersplenism and contributes to postoperative increases in platelet counts. Postoperative increases in platelet count seem to depend on platelet-associated immunoglobulin level and spleen weight, which may be valuable prognosticators.
authors.affiliation: Department of Surgery II, School of Medicine, Ehime University, Shitsukawa, Toon-Shi, 791-0295, Ehime, Japan. yuji@m.ehime-u.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Horiuchi
authors.forename: Motohira
authors.initials: M
authors.lastname: Yoshida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugishita
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Kanji
authors.initials: K
authors.lastname: Kawachi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome