title: Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series.
abstract: BACKGROUND
  Splenectomy for the treatment of hypersplenism in patients with cirrhosis (HIC) is related with complications. Laparoscopic splenic artery ligation (LSAL) may be an alternative treatment option.
  
  
  OBJECTIVE
  To evaluate safety and feasibility of LSAL in the treatment of HIC.
  
  
  METHODS
  Retrospective analysis of prospectively collected data of ten patients with HIC who were treated with LSAL from October 2012 to February 2015.
  
  
  RESULTS
  The median (range) age was 33.2 (13-56) years and sex distribution was equal. The median (range) leukocyte counts (×10(9)/L) before, and at 3, 6 and 12 months after LSAL were 2.2 (0.8-8.2) and 5.65 (2.78-10.7), 4.7 (2.8-7.8) and 4.95 (3.4-7.7) respectively. The median (range) platelet counts (×10(9)/L) before and at 3, 6 and 12 months after LSAL were 25.5 (11-65) and 75 (39-289), 74 (32-184) and 76 (56-251) respectively. Following LSAL, there was a significant improvement in total leucocyte count, platelet count and Model for End-Stage Liver Disease (MELD) score (P < 0.05). Two patients (20%) developed intraoperative bleeding and required conversion; one of these two patients developed splenic cyst that required radiological intervention. Four patients (40%) had post ligation syndrome (PLS) that was managed conservatively. During a median (range) follow-up of 19.5 (5-29) months, one patient (10%) required splenectomy due to inadequate response.
  
  
  CONCLUSIONS
  LSAL is a safe and feasible treatment option for the palliation of symptomatic HIC, however, further prospective trials are necessary for confirmation.
authors.affiliation: Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Hirdaya H
authors.initials: HH
authors.lastname: Nag
authors.affiliation: Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: Chandrasekar
authors.affiliation: Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: John M
authors.initials: JM
authors.lastname: Manipadum
authors.affiliation: Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
authors.forename: Bettageri G
authors.initials: BG
authors.lastname: Vageesh