title: Hand-assisted laparoscopic splenectomy for thrombocytopenia in patients with cirrhosis.
abstract: OBJECTIVE
  Although splenectomy plays an important role in the management of patients with liver cirrhosis, the optimal technique, open surgery, total laparoscopic surgery or hand-assisted laparoscopic surgery (HALS), has not yet been defined. The present study evaluated the outcomes of HALS splenectomy for cirrhotic patients.
  
  
  METHODS
  A total of 28 consecutive patients with cirrhosis that underwent HALS splenectomy were enrolled into this study. The preoperative laboratory and morphometric data, intraoperative variables and postoperative outcomes were reviewed from the hospital charts.
  
  
  RESULTS
  The postoperative platelet count was remarkably elevated in all cases. A re-operation was required in 1 patient complicated with postoperative hemorrhage. Enhanced CT on POD 7 revealed a high incidence of portal or splenic vein thrombosis (PSVT; 22 patients, 78.6 %). PSVT was significantly associated with higher serum bilirubin, higher indocyanine green retention value at 15 min (ICG R-15), and larger splenic vein diameter.
  
  
  CONCLUSIONS
  HALS splenectomy was a very feasible and appropriate procedure for cirrhotic patients with hypersplenism. PSVT was a frequent complication and large splenic vein diameter, high serum bilirubin, and high ICG R-15 were found to be significant risk factors for PSVT after HALS splenectomy in cirrhotic patients.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kida-gun, Kagawa, 761-0793, Japan. kymjykymjy@yahoo.co.jp
authors.forename: Keitaro
authors.initials: K
authors.lastname: Kakinoki
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Hironobu
authors.initials: H
authors.lastname: Suto
authors.forename: Minoru
authors.initials: M
authors.lastname: Oshima
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hagiike
authors.forename: Hisashi
authors.initials: H
authors.lastname: Usuki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Deguchi
authors.forename: Tutomu
authors.initials: T
authors.lastname: Masaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods*; D013162:Splenic Vein / Q000473:pathology; D013921:Thrombocytopenia / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology
chemical_list: D007208:Indocyanine Green; D001663:Bilirubin