Prevention and Management of Complications of Laparoscopic Splenectomy

Bhandarkar, Deepraj S.; Katara, Avinash N.; Mittal, Gaurav; Shah, Rasik; Udwadia, Tehemton E.

doi:10.1007/s12262-011-0331-5

Cited by 26 publications

(25 citation statements)

References 21 publications

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“… 3 , 4 , 15 , 21 Therefore, co-infected ( S. mansoni infection and HBV or HCV) patients are at higher risk for early deterioration of liver function, the development of cirrhosis, and rapid progression towards end-stage liver disease and even HCC. 20 , 21 , 23 In our sample, there were four (57.1%) patients with immunity by contact for HBV. The possible influence of this result on the disease course of these patients is unknown.…”

Section: Discussionmentioning

confidence: 73%

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Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

2015

JCTH

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Background and Aims: Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic. Methods: From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil. Results: Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died. Conclusions: It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the presence of HBV and HCV infections, likely acts as a cofactor for the hepatic lesion and potentiates injury.

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Section: Discussionmentioning

confidence: 73%

“…In studies where routine postoperative ultrasonography was done after splenectomy, the incidence of TPV ranged from 6.3 to 10.0%. 20 …”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

2015

JCTH

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“…[ 6 ] Our patient had the splenic weight of 3270 g. Unfortunately, the weight of the spleen cannot be accurately determined before surgery, but the presence of massive splenomegaly must lead to a presumption of increased risk of PVT. Thrombosis of the splenoportal axis is being increasingly recognised even after laparoscopic splenectomy,[ 7 ] being reported as high as 55% in one study. [ 8 ] This high probability of SPVT should make us reconsider the use of epidural anaesthesia and analgesia in such cases.…”

Section: Discussionmentioning

confidence: 99%

Central neuraxial blockade for splenectomy in myeloproliferative disease: A word of caution

et al. 2015

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We describe management of portal vein thrombosis (PVT) in a patient with myeloproliferative disease after splenectomy. This case posed a unique therapeutic challenge in maintaining a fine balance between life-saving thrombolysis and the risk of neuraxial complications due to bleeding. The incidence of PVT after splenectomy in patients with myeloproliferative disorders is high (40%). Anaesthesiologists should be aware of this and avoid central neuraxial blockade in such cases. If post-operative emergency thrombolysis is required in a patient having an epidural catheter in situ, it should be done under close monitoring, weighing the risks and benefits. Fibrinogen levels should be monitored to evaluate the presence of residual thrombolytic effects and to time the catheter removal.

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“…[ 2 ] However, total splenectomy may lead to overwhelming post-splenectomy infection (OPSI), portal vein thrombosis, and other complications. [ 3 , 4 ] A previous study suggested that total splenectomy may also increase the risks of pulmonary hypertension, atherosclerosis, and coronary heart disease. [ 5 ] As understanding of splenic function increases, especially immunologic function, a growing number of surgeons are implementing spleen-preserving surgery.…”

Section: Introductionmentioning

confidence: 99%

Treatment of hemangioma of the spleen by preoperative partial splenic embolization plus laparoscopic partial splenectomy

Deng¹,

Wang

et al. 2018

Medicine

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Rationale:Complete loss of splenic function increases infection and cardiovascular disease risks, so there is growing emphasis on spleen-preserving treatments, such as laproscopic partial splenectomy (LPS). However, LPS carries higher risk for hemorrhage. Sequential splenic embolization can obliterate the perilesional vascular bed while preserving flow through healthy tissue, substantially reducing risk of uncontrolled hemorrhage during LPS. Preoperative partial splenic embolization (PSE) may soften the spleen and reduce its size, which enhances space exposure for laparoscopic operation. Furthermore, immediate LPS guaranties these effects of PSE and prevents abscess, non-traumatic splenic rupture, post-embolization syndrome, and other complications. In light of these advantages, we conducted combined PSE and LPS for a case of hemangioma.Patient concerns:The patient presented with left abdominal discomfort of >1 year.Diagnoses:Ultrasound examination at the outpatient clinic identified a space-occupying lesion in the spleen. Contrast-enhanced computed tomography scan of the upper abdomen revealed a hypodense lesion, approximately 33 × 21 mm in size, located in the upper pole of the spleen, suggesting possible hemangioma.Interventions:The patient was treated by preoperative PSE followed by LPS.Outcomes:Treatment resulted in only mild intraoperative hemorrhage, fast postoperative recovery, and no recurrence during follow-up. And the postoperative histopathology confirmed splenic cavernous hemangioma.Lessions:Preoperative PSE combined with LPS is an effective therapy for elective patients that minimizes intraoperative hemorrhage during laparoscopic surgery, reduces surgical risk, and enhances surgical safety.

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Prevention and Management of Complications of Laparoscopic Splenectomy

Cited by 26 publications

References 21 publications

Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

Central neuraxial blockade for splenectomy in myeloproliferative disease: A word of caution

Treatment of hemangioma of the spleen by preoperative partial splenic embolization plus laparoscopic partial splenectomy

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