Partial splenectomy for portal hypertension in cystic fibrosis related liver disease.
OBJECTIVE
To review the middle- and long-term effects of partial splenectomy (PS) on portal hypertension (PHT) and its complications in patients with cystic fibrosis (CF) related liver disease risky PHT.


METHODS
Over a 20 years period, 19 patients aged 7-23 years underwent partial PS for massive splenomegaly, hypersplenism, and/ or severe PHT.


RESULTS
In all but three cases, PHT and hypersplenism have improved for long periods. Noticeable improvement of hepatic tests occurred simultaneously. In all patients PS resolved abdominal discomfort. Fifteen patients are alive and a stabilization of the liver disease occurred with a follow-up of 1-20 years (mean 7.9). One patient died following respiratory insufficiency 10 years after PS although PHT was stable. Manifestations recurred in 2 patients 5 and 6 years after PS. In two patients, the course of the disease evolved to hepatic insufficiency without recurrence of PHT 3 and 8 years after PS. PS did not give the expected results in three cases only, in which PHT was not modified or reoccurred during the following year. No severe complication was observed. Early (three patients) or late (one patient) eventration required surgical procedure.


CONCLUSIONS
Our results show that PS is a reliable and well-tolerated technique. Therefore, it is a therapeutic option for the management of PHT in CF patients with a preserved liver function. It can prevent and significantly delay a liver transplantation and its constraints.
Louis
Dominique
D
Pediatric Cystic Fibrosis Centre, Hospices Civilis de Lyon, Université Claude Bernard Lyon 1, Hôpital Debrousse, Lyon, France.
Duc
Mai Linh Pham
ML
Reix
Philippe
P
Chazalette
Jean-Pierre
JP
Durieu
Isabelle
I
Feigelson
Jean
J
Bellon
Gabriel
G
D000293:Adolescent; D000328:Adult; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome