Effect of laparoscopic splenectomy on portal hypertensive gastropathy in cirrhotic patients with portal hypertension.
OBJECTIVE
This study investigated the relationship between portal hypertensive gastropathy (PHG) and splenomegaly, and the effect of laparoscopic splenectomy on PHG in cirrhotic patients with portal hypertension.


METHODS
Seventy patients with liver cirrhosis and portal hypertension were prospectively studied. Indication for laparoscopic splenectomy was bleeding tendency in 10 patients, induction of interferon in 45, treatment of hepatocellular carcinoma in seven, and treatment for endoscopic injection sclerotherapy-resistant esophagogastric varices in eight. The severity of PHG was classified into none, mild, or severe according to the classification by McCormack et al. The severity of liver disease was classified using the Child-Pugh score. All patients underwent upper gastrointestinal endoscopy before and 1 month after the operation.


RESULTS
The prevalence of PHG was significantly correlated with the severity of liver disease using the Child-Pugh score. The severity of PHG was significantly correlated with the resected spleen volume. One month after the operation, PHG was improved in 16 of 17 patients with severe PHG and in 12 of 32 with mild PHG. The Child-Pugh score showed a significant improvement (6.8 +/- 1.4 to 6.2 +/- 1.2) at 3 months after laparoscopic splenectomy (P < 0.0001).


CONCLUSIONS
PHG may be associated with splenomegaly, and laparoscopic splenectomy may have a beneficial effect on PHG, at least for a short time.
Anegawa
Go
G
Department of Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. gottin@surg2.med.kyushu-u.ac.jp
Kawanaka
Hirofumi
H
Uehara
Hideo
H
Akahoshi
Tomohiko
T
Konishi
Kozo
K
Yoshida
Daisuke
D
Kinjo
Nao
N
Hashimoto
Naotaka
N
Tomikawa
Morimasa
M
Hashizume
Makoto
M
Maehara
Yoshihiko
Y
D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D020706:Laparoscopes; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013272:Stomach Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome