Partial splenectomy for portal hypertension in cystic fibrosis related liver disease

Abstract

Our results show that PS is a reliable and well-tolerated technique. Therefore, it is a therapeutic option for the management of PHT in CF patients with a preserved liver function. It can prevent and significantly delay a liver transplantation and its constraints.

Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique

“…Since this latter is mostly performed in children, with specific technical issues associated with patient small size and spleen big size, a comparison with partial splenectomy in adults is difficult. In fact, partial splenectomy in children is reported to have longer operative time [21,26] than in adults [18], both when performed by laparotomy and laparoscopy. Surprisingly, the reported morbidity of partial splenectomy in young patients is very low and not severe [5,29], whereas major complications are reported in adult patients undergoing partial splenectomy for splenic cysts, including splenic hemorrhage or infarction requiring total splenectomy [11,16,26].…”

“…In fact, partial splenectomy in children is reported to have longer operative time [21,26] than in adults [18], both when performed by laparotomy and laparoscopy. Surprisingly, the reported morbidity of partial splenectomy in young patients is very low and not severe [5,29], whereas major complications are reported in adult patients undergoing partial splenectomy for splenic cysts, including splenic hemorrhage or infarction requiring total splenectomy [11,16,26]. In this light, our technique, which implies the meticulous dissection and selective clamping of the polar vascular pedicle in order to identify the limits between vascularized and non-vascularized parenchyma, seems to reduce to a minimum the risk of a postoperative splenic infarction; moreover, the use of new stapling devices/hemostatic agents may be supposed to allow avoiding intra-and post-operative hemorrhage.…”

“…3), clearly indicating where the stapler should be placed and the parenchyma sectioned. The modality of splenic section also varies widely among surgeons, as the most frequently used tools are Ligasure ® [17,18,23] and electrocautery [5,25,26], whereas TA ® stapler/Scalpel [7,8], Ultracision ® [10,21,25] and radiofrequency [22,27] are also described. Although modern cutting/hemostatic devices (Ligasure ® , Ultracision ® , radiofrequency) are nowadays invading almost every field of surgery, our encouraging results in splenic parenchyma division by TA ® stapler may represent an argument in favor of such a low-cost, easily available device for splenic section.…”

Partial splenectomy prevents splenic sequestration crises in sickle cell disease

“…Partial splenectomy gives an alternative solution for patients not only with sickle cell disease but also for other hemoglobinopathies [3], hereditary spherocytosis [8], and portal hypertension in cystic fibrosis-related liver disease [9]. Partial splenectomy has also been performed for children with massive splenomegaly and congenital hemolytic anemias [10].…”

Cystic fibrosis-associated liver disease

“…Symptomatic portal hypertension has been successfully treated with TIPS in long-term follow-up (70 months) without clinical signs of hepatic encephalopathy [31]. Splenic artery embolisation or (partial) splenectomy in children with portal hypertension and splenomegaly can stabilise lung function and delay progression of portal hypertension [32]. Liver cirrhosis can adversely affect respiratory function secondary to organomegaly, ascites and hepatopulmonary syndrome (intrapulmonary shunts).…”