Abstract
<p>Splenic and portal vein thrombosis (SPVT) is considered as a serious complication of splenectomy with potential life-threatening. Chemoprophylaxis may help to curb the incidence of SPVT after splenectomy. This clinical trial study was conducted to determine the incidence rate of SPVT after splenectomy and investigate the effect of chemoprophylaxis to reduce its incidence. Sixty six patients undergoing open splenectomy were included in this single-blind clinical randomized controlled trial (RCT). Patients were randomly assigned in two groups of intervention and control using block randomization to either d receive 40 mg of enoxaparin subcutaneously once a day for 5 days and then 100mg aspirin for one month or no postoperative drug. After one month, all patients over a week underwent Doppler ultrasonography of the splenic, portal and superior mesenteric veins for thrombosis. The mean age of patients was similar between intervention and control groups (28.3±14.5 and 25.6±14.9, respectively) (P value=0.9).Furthermore, two groups were matched regarding distribution of gender. None of patients in intervention group developed portal vein thrombosis, while of 23 patients in control group, 2 (8.69%) subjects were diagnosed with portal vein thrombosis. The two groups had no statistically significant difference in the rate of portal vein thrombosis (P=0.18). Based on the results of our study, prophylaxis therapy had no effects in preventing portal vein thrombosis developed in patients undergoing open splenectomy for any reason.</p>
Highlights
The first splenectomy was performed in Naples by Andirano Zacarelli in 1549 on a young woman for splenomegaly (Fujita, Lyass, Otsuka, & Giordano, 2003; Ikeda et al, 2005; Stamou et al, 2006; Tran et al, 2010; Winslow, Brunt, Drebin, Soper, & Klingensmith, 2002)
Based on the results of our study, prophylaxis therapy had no effects in preventing portal vein thrombosis developed in patients undergoing open splenectomy for any reason
Underlying diseases leading to splenectomy in the intervention group included: 14 cases with trauma (42.4%), 7 cases with thalassemia major (21.2%) and 12 cases with other diseases (36.4%) such as sickle cell anemia, ITP, lymphoma, gastric cancer, splenic abscess, splenic and pancreatic cysts; and 14 cases with trauma (42.4%), 11 cases with thalassemia major (33.3%) and 8 cases with other diseases (24.2%) in control group, indicating no statistically significant differences between the two groups (P=0.4)
Summary
The first splenectomy was performed in Naples by Andirano Zacarelli in 1549 on a young woman for splenomegaly (Fujita, Lyass, Otsuka, & Giordano, 2003; Ikeda et al, 2005; Stamou et al, 2006; Tran et al, 2010; Winslow, Brunt, Drebin, Soper, & Klingensmith, 2002). Complications after splenectomy are left lung lobe atelectasis, pneumonia, pulmonary edema, intraoperative and postoperative hemorrhage, sub-diaphragmatic abscess, pancreatitis, pancreatic fistula, pancreatic pseudocyst, deep vein thrombosis and splenic, superior mesenteric and portal veins thrombosis (Cadili & de Gara, 2008; James et al, 2009; Targarona, 2008). Clinical signs of SPVT include portal vein hypertension as esophageal varices, upper gastrointestinal bleeding (UGIB) and hypersplenism and intestinal ischemia (Janssen et al, 2001). The risk factors for SPVT include lymphoma, lymphoproliferative disorder, hemolytic anemia associated with splenomegaly (more than 650 grams), splenic vein diameter greater than 8 mm and hyper-coagulopathy (Qi, Bai, Guo, & Fan, 2014; Schettino, Fagundes, Roquete, Ferreira, & Penna, 2006). High possibility of SPVT can be seen in laparoscopic gjhs.ccsenet.org
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