title: A laparoscopic splenectomy allows the induction of antiviral therapy for patients with cirrhosis associated with hepatitis C virus.
abstract: It is difficult to treat patients with cirrhosis-associated hepatitis C with pegylated interferon (PEG-IFN) and ribavirin because of thrombocytopenia-related hypersplenism. Both safety and clinical efficacy were retrospectively analyzed for patients who underwent a laparoscopic splenectomy (LS) from January 2003 to December 2007. A total of 35 patients with cirrhosis associated with hepatitis C virus had LS for thrombocytopenia before PEG-IFN and ribavirin therapy, and all patients had thrombocytopenia, which was a contraindication for antiviral therapy. The hepatopathy was Child A in 24 patients, Child B in 10 patients, and Child C in one patient. All 35 patients increased platelet count from 48,000 +/- 15,000 to 155,000 +/- 55,000/microl (P < 0.0001) after LS. The median hospital stay and blood loss were 13.0 days (range, 8 to 57 days) and 342.0 mL (range, 5 to 2350 mL). There was no postoperative death. Twenty-nine (83%) patients had PEG-IFN and ribavirin therapy after LS; 18 had complete therapy and 11 had partial therapy. Of these, nine had a sustained virologic response. A laparoscopic splenectomy for patients with cirrhosis associated with hepatitis C virus can be performed safely and allows induction of antiviral treatment.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Shigekawa
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Takashi
authors.initials: T
authors.lastname: Hama
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayami
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D000075202:Contraindications; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D010535:Laparoscopy; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D013156:Splenectomy / Q000379:methods*; D013921:Thrombocytopenia / Q000601:surgery
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a