title: Value of laparoscopic splenectomy as salvage treatment for relapsed thrombocytopenia after partial splenic arterial embolization.
abstract: OBJECTIVE
  Recently, partial splenic arterial embolization (PSE) has become a supportive intervention for cirrhotic patients with hypersplenism in the administration of interferon therapy. However, relapsed thrombocytopenia is often observed in patients following PSE. This study aimed to report the clinical efficiency of laparoscopic splenectomy as a salvage treatment for relapsed thrombocytopenia following PSE.
  
  
  METHODS
  From 2005 to 2009, 6 patients with prior PSE treatment underwent laparoscopic splenectomy. We reviewed the surgical method of laparoscopic splenectomy and the peri- and postoperative outcomes.
  
  
  RESULTS
  Laparoscopic splenectomy effectively provided sufficient increases in patient platelet counts. In all patients, laparoscopic splenectomy was performed safely with no significant complications despite PSE-associated dense adhesion to the diaphragm and/or retroperitoneal attachments.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy provides a sufficient increase in patient platelet counts in relapsed thrombocytopenia following PSE. Therefore, laparoscopic splenectomy appears to be a superior supportive therapy for the treatment of thrombocytopenia in cirrhotic patients.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan. naotakak@surg2.med.kyushu-u.ac.jp
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Kozo
authors.initials: K
authors.lastname: Konishi
authors.forename: Hideo
authors.initials: H
authors.lastname: Uehara
authors.forename: Nao
authors.initials: N
authors.lastname: Kinjo
authors.forename: Daisuke
authors.initials: D
authors.lastname: Korenaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Takenaka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000150:complications; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy; D013921:Thrombocytopenia / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome