Recommended timing for surveillance ultrasonography to diagnose portal splenic vein thrombosis after laparoscopic splenectomy.
BACKGROUND
Symptomatic portal or splenic vein thrombosis (PSVT) is a rare but potentially lethal complication of laparoscopic splenectomy (LS). While routine postoperative duplex ultrasound surveillance can be used for early detection, the optimal timing is unknown. The aim of this study is to investigate the incidence and progression of asymptomatic PSVT 1 week and 1 month after LS.


METHODS
Consecutive patients scheduled for LS for hematologic disease participated in this study. Patients underwent surveillance for PSVT using duplex ultrasonography 1 week and 1 month postoperatively.


RESULTS
43 of 48 patients planning to undergo LS in the study period were enrolled, with 3 subsequently excluded, leaving 40 for further analysis. The indications for LS were benign disease in 31 [19 had immune thrombocytopenia purpura (ITP)] and malignant disease in 9. A hand-assisted technique was used in 12 cases. PSVT was diagnosed in 9/40 patients (22.5%). Seven (77.8%) were diagnosed by 1 week with ultrasound, of whom one had mild symptoms (fever and diarrhea). After anticoagulation, subsequent ultrasounds showed resolution or improvement in all seven patients. Thirty-three patients had a normal ultrasound result at 1 week. One of these patients also had a computed tomography (CT) scan that found a PSVT not seen on ultrasound. Twenty-seven patients returned for follow-up after normal 1-week imaging: 26 patients had an ultrasound at 1 month, with no new PSVT found. One additional patient did not return for subsequent ultrasound until 2 months later, when a new distal SVT was found; ultrasound at 6 months showed complete resolution without treatment.


CONCLUSIONS
The 1-week incidence of PSVT after LS was 8/40 (20%). The high incidence justifies ultrasonographic screening on postoperative day 7. If asymptomatic PSVT has not developed at this time, it is unlikely to develop by 1 month, and subsequent screening ultrasound at 1 month is not required.
Tran
Tung
T
Department of Surgery, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, L9-313, Montreal, QC, H3G 1A4, Canada.
Demyttenaere
Sebastian V
SV
Polyhronopoulos
Gerry
G
Séguin
Chantal
C
Artho
Giovanni P
GP
Kaneva
Pepa
P
Fried
Gerald M
GM
Feldman
Liane S
LS
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D018450:Disease Progression; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D013154:Spleen / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects*; D013162:Splenic Vein / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology
D000925:Anticoagulants