Significance of Laparoscopic Splenectomy in Patients with Hypersplenism

Watanabe, Yuji; Horiuchi, Atsushi; Yoshida, Misao; Yamamoto, Yuji; Sugishita, Hiroki; Kumagi, Teru; Hiasa, Yoichi; Kawachi, Kanji

doi:10.1007/s00268-006-0504-8

Cited by 65 publications

(51 citation statements)

References 32 publications

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“…1). 8,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] All were observational studies with methodological limitations (Table 1): seven non-randomized comparative studies and nine case series. The included studies can be divided into two subgroups according to surgical procedures: LS group and LSD group.…”

Section: Included Studiesmentioning

confidence: 99%

“…Low-risk patients with Child-Pugh class A and B are preferred, whereas patients with class C are contraindicated. In the reviewed publications, indications for LS included bleeding tendency due to severe thrombocytopenia (platelet counts <30 ¥ 10 9 /L), 8,21,22,32 difficulties with induction or continuation of pegylated interferon (IFN) therapy due to thrombocytopenia, 8,[19][20][21]23 and difficulties with therapies for HCC due to thrombocytopenia. 8,20,21 LSD was indicated for patients with severe portal hypertension such as medical and endoscopic treatment-resistant oesophagogastric varices 9,25,[27][28][29][30][31][32] and solitary gastric varices.…”

Section: Surgical Indicationsmentioning

confidence: 99%

“…Seven studies were identified with comparisons between laparoscopic and open procedures (four comparisons of LS with OS 20,22,24,32 and four comparisons of LSD with OSD [29][30][31][32] ). The main outcome measures reported are seen in Table 5.…”

Section: Comparisons Between Laparoscopic and Open Proceduresmentioning

confidence: 99%

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Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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Background: Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. Objectives: A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. Methods: A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. Results: Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. Conclusions: The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.

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Section: Included Studiesmentioning

confidence: 99%

Section: Surgical Indicationsmentioning

confidence: 99%

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Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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“…However, surgical intervention exhibits certain disadvantages and poses several risks. Postoperative morbidity is dominated by a severe syndrome known as Overwhelming post-splenectomy infection (OPSI), which is due to encapsulated bacteria such as pneumococci [5]. Total splenectomy should be avoided and limited to selected cases, the more so as it can be successfully replaced by an interventional technique with minimal complications.…”

Section: Introductionmentioning

confidence: 99%

Partial Splenic Embolization for Hypersplenism in Cirrhotic Patients. A Case Series

Omer¹,

Zara

Iacobescu

et al. 2014

JGLD

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The prognosis of liver cirrhosis depends on the presence of its major complications as well as on other factors such as hypersplenism with thrombocytopenia. Partial splenic embolization is an effective interventional procedure performed in liver cirrhosis complicated with portal hypertension to improve the low platelet count. This technique represents an efficient alternative to splenectomy, which has major drawbacks and is associated with a high morbidity. We report a series of patients with liver cirrhosis and portal hypertension who presented with severe thrombocytopenia and were treated with partial splenic embolization eventually having a favourable outcome.

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“…There are several methods to treat thrombocytopenia in cirrhotic hypersplenism, such as open or laparoscopic splenectomy, [6][7][8][9] partial splenic embolization, [9][10][11] radiofrequency ablation (RFA) 12,13 and use of a thrombopoietin receptor agonist (eltrombopag). 14,15 The choice of treatment method depends on balancing efficacy and accompanying complications.…”

mentioning

confidence: 99%

Electromagnetic thermoablation to treat thrombocytopenia in cirrhotic and hypersplenic rats

Akahoshi

Hashizume

2010

J of Gastro and Hepatol

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Do the above observations have any clear messages? One is that myocardial ischemia during ERCP or other endoscopic procedures is probably more common than is currently recognized. A second message is that the stress response prior to or during procedures such as ERCP may influence the frequency of complications such as pancreatitis. This could be examined in a practical way by determining whether the frequency of ERCP pancreatitis is lower with unconscious sedation than with conscious sedation or whether ERCP pancreatitis can be minimized by sedation or sympathetic blockade prior to the procedure or even by the use of ampullary anesthesia prior to cannulation. Thrombocytopenia is a common condition in cirrhotic patients with hypersplenism. 1,2 Although this condition is not lifethreatening itself, it can interfere with several treatments, such as endoscopic treatment, percutaneous ablation, surgery, and interventional radiology. Thrombocytopenia has been shown to be disadvantageous for treatment with pegylated interferon/ribavirin combination therapy in patients with hepatitis C virus-related hepatitis. 24 References3-5 Therefore, an effective treatment for thrombocytopenia is required.There are several methods to treat thrombocytopenia in cirrhotic hypersplenism, such as open or laparoscopic splenectomy, [6][7][8][9] partial splenic embolization, 9-11 radiofrequency ablation (RFA) 12,13 and use of a thrombopoietin receptor agonist (eltrombopag).

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Significance of Laparoscopic Splenectomy in Patients with Hypersplenism

Cited by 65 publications

References 32 publications

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Partial Splenic Embolization for Hypersplenism in Cirrhotic Patients. A Case Series

Electromagnetic thermoablation to treat thrombocytopenia in cirrhotic and hypersplenic rats

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