Postsplenectomy Portal, Mesenteric, and Splenic Vein Thrombosis

Liang, Mike K.

doi:10.1001/archsurg.142.6.575-a

Cited by 6 publications

(1 citation statement)

References 3 publications

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“…Recent reports question whether the technique used for splenic vessel ligation (stapled vascular transection en masse) may contribute to the increased rate of thrombosis in patients who undergo laparoscopic versus open techniques. 10 Our centre consistently uses a laparoscopic vascular stapler for control of the splenic hilum, and owing to the low incidence of SPVT observed, we do not believe that this surgical technique contributed to our 1 case of SPVT. Our reported bleeding complication rate was 7%, as compared with the 4% reported by the Lovenox monograph; 11 however, owing to our small sample size, we cannot draw any meaningful conclusions.…”

Section: Recherchementioning

confidence: 91%

Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy

Wang

Kopac²,

Brisebois³

et al. 2011

Can J Surg

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RESEARCH • RECHERCHERandomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy Background: Splenic and portal vein thrombosis (SPVT) is a potentially lifethreatening complication of splenectomy. There is a paucity of studies examining the role of prophylactic pre-and postoperative anticoagulation in the prevention of this complication. We designed a prospective randomized controlled trial (RCT) to more rigorously address the impact of prophylactic anticoagulation on the incidence of asymptom atic or symptomatic SPVT, detected on Doppler ultrasound, after laparoscopic splenectomy.Methods: This 2-centre, phase II, prospective, open-label, parallel-assignment RCT compared no postoperative anticoagulation to a regimen of 40 mg of enoxaparin subcutaneously once daily for 21 days. All patients underwent Doppler ultrasonography of the splenoportal system preoperatively and again 14-28 days after surgery to screen for nonocclusive or occlusive thrombosis.Results: From November 2006 to November 2008, 35 patients were enrolled in the RCT. Four patients withdrew, 1 required conversion to an open procedure and 1 died at 3 months (the cause of death was not related to the study). Of the 29 patients remaining, 15 were randomly assigned to the anticoagulation group and 14 to the nonanticoagulation group. One (3.4%) patient in the treatment group experienced portal thrombosis. Rates of postoperative bleeding were similar in both groups. Conclusion:This RCT of anticoagulation found a low overall risk of SPVT after laparoscopic splenectomy; however, this is an underpowered study, and further multicentred clinical trials are needed.Contexte : La thrombose de la veine splénique et porte (TVSP) est une complication de la splénectomie qui peut menacer la vie. Peu d'études se sont penchées sur le rôle de l'anticoagulation pré-opératoire et postopératoire prophylactique dans la préven-tion de cette complication. Nous avons conçu un essai contrôlé randomisé (ECR) prospectif afin d'analyser plus rigoureusement l'effet de l'anticoagulation prophylactique sur l'incidence de la TVSP asymptomatique ou symptomatique, détectée par échographie Doppler, après une splénectomie par laparoscopie.

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Section: Recherchementioning

confidence: 91%