Recent role of splenectomy in chronic hepatic disorders

Abstract

For years splenectomy in hepatic disorders has been indicated only for the treatment of gastro-esophageal varices. However, with recent advances in medical and surgical treatments for chronic hepatic disorders, the use of splenectomy has been greatly expanded, such that splenectomy is used for reversing hypersplenism, for applying interferon treatment for hepatitis C, for treating hyperdynamic portal circulation associated with intractable ascites, and for controlling portal pressure during small grafts in living donor liver transplantation. Such experiences have shown the importance of portal hemodynamics, even in cirrhotic livers. Recent advances in surgical techniques have enabled surgeons to perform splenectomy more safely and less invasively, but the procedure still has considerable clinical outcomes. Splenectomy in hepatic disorders may become a more common procedure with expanded indications. However, it should also be noted that the long-term effects of splenectomy, in terms of improved hematological or hepatic function, is still not guaranteed. Moreover, the impact of splenectomy on immunologic status remains unclear and needs to be elucidated in both experimental and clinical settings.

Value of Laparoscopic Splenectomy as Salvage Treatment for Relapsed Thrombocytopenia after Partial Splenic Arterial Embolization

“…With the recent advances in laparoscopic technology, laparoscopic splenectomy has now become a feasible and efficient treatment for patients with cirrhosis as a minimally invasive surgery [13,14,15,16,17,18,30]. However, patients previously treated with PSE have until recently presented several difficulties.…”

“…When IFN therapy was administered to eradicate HCV, hypersplenism-associated thrombocytopenia often becomes a problem. Therefore, both PSE and surgical splenectomy have been widely used for the treatment of thrombocytopenia-associated liver diseases prior to the onset of IFN therapy in order to eradicate HCV [8,9,10,11,12,13,14,15,16,17,18]. However, the use of PSE or surgical splenectomy as the first line of treatment for thrombocytopenia remains controversial.…”

“…Surgical splenectomy is a treatment that can fully remove the pooling site of platelets and can therefore achieve increases in platelet counts in a more efficient manner [13,14,15,16,17,18,20]. Recently, we experienced 6 patients exhibiting relapsed thrombocytopenia who had previously received PSE treatment.…”

“…Sufficient increases in platelet counts are achieved in most patients following either PSE or surgical splenectomy [8,9,10,11,12,13,14,15,16,17,18,20], whereas clinical relapses into thrombocytopenia have occurred in several patients, especially those exhibiting PSE [12,20,21], and these relapses were mainly associated with insufficient infarcted spleen volumes [12,21,22]. Those patients exhibiting relapsed thrombocytopenia thus require either dose reduction or treatment discontinuation, and these patients subsequently experience difficulties in eradicating HCV and also require additional treatments for thrombocytopenia.…”

“…Recently, treatments such as partial splenic arterial embolization (PSE) and surgical splenectomy have attempted to correct splenomegaly-associated thrombocytopenia [8,9,10,11,12,13,14,15,16,17,18] because the only current tool that improves thrombocytopenia is the administration of platelet infusions [19]. Sufficient increases in platelet counts are achieved in most patients following either PSE or surgical splenectomy [8,9,10,11,12,13,14,15,16,17,18,20], whereas clinical relapses into thrombocytopenia have occurred in several patients, especially those exhibiting PSE [12,20,21], and these relapses were mainly associated with insufficient infarcted spleen volumes [12,21,22].…”