Hypersplenism In Patients Research Articles

Splenectomy in Thalassemia: The Role of Surgery as an Adjunct to Medical Management.

Introduction Beta thalassemia is a hemoglobinopathy characterized by defective production of the beta chain of hemoglobin, leading to irreversible destruction of RBCs, splenomegaly, pancytopenia, and a requirement for multiple transfusions. This condition necessitates iron chelation therapy, and splenectomy is often performed to manage hypersplenism. Methods This report includes a series of seven diagnosed cases of beta thalassemia with hypersplenism, all of whom underwent open splenectomy. Preoperative transfusions were administered to achieve target hemoglobin and platelet counts of 9 g/dL and 50,000/µL, respectively. Results The study included seven patients diagnosed with beta thalassemia, all of whom underwent open splenectomy. Among these, three patients also had concomitant cholecystectomy due to the presence of gallstones. The primary indication for performing splenectomy was hypersplenism. Preoperative transfusions were administered to ensure target hemoglobin levels of 9 g/dL and platelet counts of 50,000/µL. All patients were successfully discharged with minimal morbidity and no reported mortality. The longest follow-up period observed in this series was 10 months post-splenectomy, which limited the assessment of long-term effects. Conclusion Open splenectomy for hypersplenism in patients with beta thalassemia appears to be a safe and effective procedure with minimal short-term morbidity and no mortality observed in this series. However, due to the limited follow-up duration, the long-term effects of splenectomy in these patients could not be evaluated. Further studies with longer follow-up are needed to assess the long-term outcomes of splenectomy in beta thalassemia patients.

"Hypersplenism in Patients with Liver Cirrhosis and Portal Hypertension: Predictors, and Correlations"

"Hypersplenism in Patients with Liver Cirrhosis and Portal Hypertension: Predictors, and Correlations"

Ендоваскулярні втручання в комплексній терапії пацієнтів із портальною гіпертензією і кровотечею з варикозно розширених вен

For today, endovascular procedures, such as embolization of splenic artery, transjugular intrahepatic shunt, and retrograde transvenous obliteration with balloon occlusion are widely applied in the treatment and prophylaxis of variceal bleeding in patients with portal hypertension. Splenomegaly with the development of hypersplenism is one of complications of portal hypertension in patients with liver cirrhosis, which can negatively be influenced on clinical course. Due to that, it can be assumed that the management of hypersplenism in patients with portal hypertension with the applying of splenic artery embolization, could be improve the results of treatment of this group of patients. Purpose - to summarize the own experience of the applying of splenic artery embolization in the complex therapy in patients with portal hypertension that complicated by the variceal bleeding. Materials and methods. This study based on the results of treatment of 36 patients, in which the embolization of splenic artery was applied in the complex management (conventional treatment and endoscopic ligation of varices). The classic method of “chronic” occlusion was used for the embolization. The embolization on the level of the initial portion of the main trunk of splenic artery was performed in 30 (83.3%) of patients. Due to the anatomical peculiarities of vasculature, embolization was performed on the level of middle part of splenic artery in 6 (16.7%) of patients. The effectiveness of the treatment was evaluated by the changes of complete blood count indices and ultrasonography results. Statistical analysis was performed using the program SPSS Statistic for Windows, version 15.0 (IBM Corp., Armonk, NY, USA). Results. The middle age of patients was 55.8±1.6 years. The middle value of Child-Turcotte-Pugh criterion was 2.44±0.08, and MELD score was 16.36±0.99 value. Conclusions. The applying of splenic artery embolization that combined with conventional therapy and endoscopic ligation of varices is appropriate and justified. Embolization of the splenic artery promotes to decrease of appearance of hypersplenism in patients with the portal hypertension with positive influence on follow-up clinical course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Nomogram for prediction of portal vein system thrombosis after splenectomy for hypersplenism in patients with Wilson disease.

The occurrence of portal vein system thrombosis (PVST) after splenectomy in patients with Wilson disease (WD) can lead to serious complications. The early identification of high-risk patients can help improve patient prognosis. This study aimed to establish and validate a personalized nomogram for assessing the risk of PVST after splenectomy in patients with WD and hypersplenism. We retrospectively collected the data from 81 patients with WD and hypersplenism who underwent splenectomy. Based on whether PVST occurred within a month after the operation, they were divided into the PVST group and the non-PVST group. The clinical data of the 2 groups were compared, and univariate analysis was used to select the statistically significant features and incorporated into the least absolute shrinkage and selection operator (LASSO) regression model for optimization. Multivariate logistic regression analysis was used to determine the independent risk factors for PVST after splenectomy, which were then applied to establish a personalized nomogram. We calculated the concordance (C)-index and drew the receiver operating characteristic (ROC) curve, the model calibration curve, and the clinical decision analysis (DCA) curve to evaluate the accuracy, calibration, and clinical applicability of the model, respectively. We used bootstrapping for internal validation of the model. Univariate analysis showed that the differences in preoperative portal vein diameter and velocity of portal blood flow, postoperative mean platelet volume (MPV), mean platelet distribution width (PDW), D-dimer, prothrombin time (PT), and the increase of platelet count (PLT) were of statistical significance (P<0.05). According to the results of the LASSO and multivariate logistic regression analyses, a model including preoperative portal vein diameter, preoperative portal blood flow velocity, postoperative D-dimer, and the increase of PLT was established to predict the risk of PVST after splenectomy. The model showed good accuracy with a C-index of 0.838 (95% CI: 0.750-0.926) and had a well-fitted calibration curve. Furthermore, internal validation showed it achieved a moderate C-index of 0.805. The DCA curve indicated that the model has clinical applicability when patients are treated at thresholds of 2-100%. Establishing a predictive model for the risk of PVST in patients with WD and hypersplenism after splenectomy can help clinicians identify patients at high risk of PVST who require intervention measures.

Minimally invasive treatment of cirrhotic secondary hypersplenism with high-intensity focused ultrasound

High-intensity focused ultrasound (HIFU) has been reported to be a minimally invasive effective method for the treatment of secondary hypersplenism. However, neither the short-term efficacy nor the indications and/or contraindications have been described in patients with cirrhosis. From October 2019 to May 2021, eleven cases of patients with cirrhotic secondary hypersplenism were enrolled. The blood counts, liver function tests and abdominal ultrasound and/or MRI scans of all patients were closely evaluated. Among these 11 patients, eight (72.7%) patients were classified as Child–Pugh A, and the other 3 (27.3%) patients were Child–Pugh B; Five (45%) patients were diagnosed with gallstone, including multiple small stones in 2 patients and single stone in 3 patients. HIFU was performed successfully in all 11 patients. After HIFU, hematologic parameters and liver function were significantly improved in all 11 patients (p < 0.05). The HIFU ablated volume to spleen volume rate was 35–61%. Complications were ecchymosis of the waist in 7 (63.3%) patients, ablated area pain in 3 (27.3%) patients, and choledocholithiasis in 2 (18.2%) patients with multiple small gallstones. All of them recovered smoothly without additional treatment except for 2 patients with choledocholithiasis recovered with risky endoscopic retrograde cholangiopancreatography (ERCP) treatment. This series suggested that HIFU is an effective and safe treatment for cirrhotic secondary hypersplenism in patients classified as Child–Pugh A or B. However, multiple small gallstones could be a relative contraindication for it.

Liver stiffness assessed by real-time two-dimensional shear wave elastography predicts hypersplenism in patients with Wilson\u2019s disease: a prospective study

BackgroundThe current study aimed to explore the value of liver stiffness assessed by two-dimensional real-time shear wave elastography (2D-SWE) to predict hypersplenism occurrence in Wilson’s disease (WD) patients.MethodsNinety WD patients were enrolled in this prospective study between May 2018 and December 2018. Baseline clinical data and ultrasound imaging including 2D-SWE liver stiffness of WD patients were collected. After enrollment, patients had follow-ups for 24 months or until they developed hypersplenism. The hypersplenism risk factors were determined using Cox regressions and receiver operating characteristic curves (ROC).ResultsTwenty-nine (32.2%) patients developed hypersplenism. Age, portal vein diameter, and liver stiffness were independent hypersplenism risk factors in WD patients. The cutoff value of liver stiffness to predict hypersplenism was 10.45 kPa, with sensitivity and specificity of 75.9% and 73.8%, respectively. Patients were divided into two groups according to liver stiffness: ≥ 10.45 kPa (57.9% with hypersplenism) or < 10.45 kPa (13.5% with hypersplenism). The median time between enrollment and hypersplenism development was 15 months vs. 22 months (p < 0.001) for the two groups, respectively.ConclusionThe measurement of liver stiffness by 2D-SWE can be a reliable hypersplenism predictor in WD patients. Therefore, dynamic monitoring of WD patients using 2D-SWE is crucial for the early diagnosis of hypersplenism.

＜Editors' Choice＞ Long-term outcomes of the partial splenectomy for hypersplenism after portoenterostomy of patients with biliary atresia.

ABSTRACTMassive splenomegaly and hypersplenism in patients with biliary atresia after Kasai portoenterostomy were treated with partial splenic embolization or total splenectomy. We performed partial splenectomy to reduce the complications of partial splenic embolization and avoid overwhelming post-splenectomy infection. This study aimed to evaluate the long-term effects of partial splenectomy for hypersplenism on postoperative liver and spleen function in patients with biliary atresia. Among jaundice-free patients with biliary atresia who underwent Kasai portoenterostomy between January 1992 and December 2012, 15 underwent partial splenectomy for massive splenomegaly and hypersplenism at our institution. Changes in the laboratory data 10 years post partial splenectomy were retrospectively investigated, and these along with the latest data were measured. A total of four patients (27%) required living-donor liver transplantation after partial splenectomy, a proportion similar to those who did not undergo partial splenectomy. Compared to the preoperative baseline, the platelet counts were significantly higher at 1 and 3 years after surgery (p < 0.05). Aspartic aminotransferase-to-platelet ratio index was significantly lower at 1, 7, and 10 years after partial splenectomy (p < 0.05). No further surgeries were required for hypersplenism after partial splenectomy over 10 years, and there were no cases of overwhelming post-splenectomy infection after partial splenectomy. Partial splenectomy is safe and effective for the treatment of hypersplenism with biliary atresia over a long time period. It could be considered as an alternative to partial splenic embolization as it can suppress hypersplenism for a long time and induces fewer postoperative complications.

Thalidomide for the Treatment of Thrombocytopenia and Hypersplenism in Patients With Cirrhosis or Thalassemia.

Hypersplenism and thrombocytopenia are common complications of liver cirrhosis or thalassemia, but current treatment strategies are limited. This study aimed to evaluate the efficacy and safety of thalidomide in the treatment of hypersplenism and thrombocytopenia in patients with liver cirrhosis or thalassemia. A total of 31 patients with hepatic cirrhosis (n=19) or thalassemia (n=12) diagnosed with hypersplenism and thrombocytopenia (platelet count [PLT] <100×109/L) were included in this prospective cohort study between January 2015 and May 2017. Patients were treated with thalidomide (150–200 mg/d) plus conventional therapy. Spleen length, PLT, leukocyte count (WBC), absolute neutrophil count (ANC), and hemoglobin level (Hb) were measured at baseline, 3, 6, and 12 months. Any adverse events were noted. All of the 31 patients were showed a progressive increase PLT during the 12-month follow-up, and similar results were obtained when subgroup analyses were performed based on the primary disease (cirrhosis or thalassemia). WBC, ANC, and Hb also increased progressively during the 12-month follow-up. Spleen length decreased progressively during the follow-up. No serious adverse events occurred. Thalidomide is a potential treatment for thrombocytopenia caused by hypersplenism in patients with cirrhosis or thalassemia.

Clinical efficacy of partial splenic arterial embolization in treatment of hypersplenism in patients with HBV-related cirrhosis

收集2012年1月至2018年4月收治的452例乙型肝炎肝硬化脾功能亢进患者资料，比较患者部分脾动脉栓塞术前及术后1周、1、3、6个月外周血细胞计数及肝脏合成功能。结果显示部分脾动脉栓塞术能有效改善肝硬化后脾功能亢进，一定程度上改善肝脏合成功能，减少肝硬化脾功能亢进患者医疗费用，是肝硬化脾功能亢进患者行之有效的治疗措施。.

Percutaneous Microwave Ablation versus Partial Splenic Embolization for Treatment of Hypersplenism in Patients with Liver Cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE.

Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension.

IntroductionThe role of laparoscopic selective esophagogastric devascularization and splenectomy (LSEGDS) in the treatment of esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension has not been well studied.AimTo investigate the safety and efficacy of LSEGDS for esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension.Material and methodsFrom May 2011 to December 2014, 74 patients with portal hypertension resulting from liver cirrhosis underwent surgery for gastroesophageal variceal bleeding and hypersplenism. Forty-one of these patients underwent laparoscopic esophagogastric devascularization and splenectomy (LEGDS), and the others underwent LSEGDS. A retrospective comparative analysis of clinical data was conducted between the two groups, including clinical characteristics, laboratory data, operative morbidity and mortality, and outcomes of follow-up.ResultsThe operation was completed successfully in all the patients, except that conversion was required in one patient in the LEGDS group. The operating time was similar in both groups (p = 0.579). The intraoperative blood loss was lower in the LSEGDS group (p = 0.011). Postoperative complications showed no significant difference between the two groups regarding mortality rate, pleural effusion, pancreatic injury, pulmonary infection, liver dysfunction, or postoperative abdominal bleeding. Postoperative platelet counts increased significantly more in the LEGDS group than in the LSEGDS group (p = 0.004). There were no significant differences in the long-term follow-up data, such as incidence of rebleeding, portal vein thrombosis, hepatic encephalopathy and survival (p > 0.05).ConclusionsThe LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins.

Spare the Spleen in ALPS: It Is Not an Expendable Vestigial Organ

Background:Autoimmune lymphoproliferative syndrome (ALPS-FAS) due to inherited and somatic FAS genetic defects is associated with childhood onset lymphadenopathy, splenomegaly, multilineage cytopenias, and an increased life-time risk of B-cell lymphoma. More than two hundred patients with ALPS-FAS and their relatives have been followed at NIH and CHOP since 1993. Though splenectomy was the go to remedy until early 2000s, steroid and spleen sparing immunomodulatory regimens have been the mainstay of long term therapy in recent years for many ALPS patients with refractory cytopenias secondary to autoimmune destruction and splenic sequestration. This included mycophenolate mofetil (n=54), rapamycin (n=17 at NIH and n=22 at CHOP), rituximab (n=25), plaquenil (n=4), and TPO-mimetics (n=4).Patients and Observations:In our cohort; 80 patients had a splenectomy before 2005, compared to only 26 patients that endured a splenectomy between 2005 and 2018 among NIH cohort and none at CHOP. Post splenectomy sepsis related morbidity and mortality were noted to be considerable. More ALPS patients in our cohort have perished due to overwhelming post splenectomy sepsis(n=10) and non-availability of timely medical care than all other causes of death cumulatively, including deaths due to lymphoma (n=5). This change of practice was predicated upon the success of regimens containing long term use of mycophenolate mofetil (Rao VK et al. Use of mycophenolate mofetil for chronic, refractory immune cytopenias in children with autoimmune lymphoproliferative syndrome. Br J Haematol. 2005 May; 129(4):534-8) or rapamycin (Bride KL et al. Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial. Blood. 2016 Jan 7;127(1):17-28. doi: 10.1182/blood-2015-07-657981). Though rapamycin was more potent against the underlying lymphoproliferative process of ALPS, some patients could not tolerate its side effects: mouth ulcers, increased lipids, molluscum, warts, deep vein thrombosis and peripheral edema. Notable toxicities were persistent secondary hypogammaglobulinemia (n=20/25) following rituximab and prolonged use of mycophenolate mofetil.Conclusion:Splenectomy and rituximab should be avoided in ALPS-FAS. Though successfully used in many patients, we still need to be wary of the short and long-term toxicities of both rapamycin and MMF. Though it may sound self-evident to avoid splenectomy today, even in early 2010s we have had a 1year old child with ALPS-FAS undergoing unwarranted splenectomy. Splenectomy for an enlarged spleen for a diagnostic or therapeutic purpose should be avoided under many circumstances unless indicated as a last resort. (Kristinsson SY et al. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica. 2014 Feb;99(2):392-8. doi: 10.3324/haematol.2013.092460. PMID: 24056815).Experience gained from long term management of nonmalignant lymphoproliferation in rare disorders like ALPS can also be applicable to lymphadenopathy, splenomegaly and hypersplenism in patients with sporadic ITP and other inherited disorders of immune system, due to defects in genes like PIK3CD, PIK3R1, CTLA4, LRBA and STAT3GOF etc. using spleen sparing long term immunosuppressive/immunomodulatory medications.Future Directions:It is desirable to create an all cause iatrogenic/surgical asplenia registry for all patients (both pediatric and adults) under the auspices of ASH. This registry should prospectively collect data about patients that have undergone splenectomy and follow them for the long term and document their associated life time comorbidities. This will help us in developing standardized prophylactic asplenia care protocols. (A registry for patients with asplenia/hyposplenism reduces the risk of infections with encapsulated organisms. Arnott A, Jones P, Franklin LJ, Spelman D, Leder K, Cheng AC. Clin Infect Dis. 2018 Feb 17. doi: 10.1093/cid/ciy141. [Epub ahead of print])Targeted physiological restoration of the fas or other affected protein function is desirable in symptomatic patients with ALPS and similar inherited disorders of non-malignant lymphoproliferation as a long-term therapeutic approach starting from childhood and continued into late adulthood. DisclosuresRao:novartis: Research Funding. Uzel:Novartis: Research Funding. Teachey:La Roche: Consultancy; Amgen: Consultancy.

Treatment of hypersplenism in patients with portal hypertension of hepatic cirrhosis

Hypersplenism is a common clinical manifestation of portal hypertension in hepatic cirrhosis. Clinical treatment of hypersplenism includes splenectomy, partial splenic embolization and liver transplantation. Splenectomy and partial splenic embolization are effective for hypersplenism, but the main complications are portal / splenic vein thrombosis (PSVT) and infection. Liver transplantation is an ideal method for the treatment of hypersplenism caused by cirrhosis, but patients with liver transplantation may still have persistent hypersplenism. Simultaneous splenectomy or partial splenic embolization which is performed with liver transplantation is a therapy of persistent hypersplenism. It can improve the function of graft but also increase the risk of infection. Key words: Hypersplenism; Splenectomy; Partial splenic embolization; Liver transplantation

The Effect of Partial Ѕplenic Artery Embοlizatiοn in The Cοntrοl of Hyperѕpleniѕm

Aim of the work: A descriptive study to investigate the effect of partial splenic artery embolization in the control οf hyperѕpleniѕm. Patients and methods: Fifteen patient with hyperѕpleniѕm due to chronic liver disease were included. This was a prospective study that included patients with thrombocytopenia (platelet count <70.000) which referred from the Tropical Department at Ain Shams University Hospitals to the Interventional Radiology Unit for partial splenic embolization. Partial splenic arterial embolization was performed to reduce the hyperfunction of the spleen in patient with hypersplenism. Results: The mean age of the selected patients was about 48years old. The most common cause of hypersp1enism is chronic 1iver disease due to HCV infection in 12 patients (80%), bi1harzial disease in 2 patients (13%) and mixed HCV and bi1harzial infection in 1 patient (7%). The moѕt frequent riѕk factorѕ were paѕt history of b1ood transfusion in 7 patientѕ (47%), paѕt history of ѕurgery in 5 patientѕ (33%), and paѕthiѕtory of parentral antibilharzia1 treatment in 3 patientѕ (20%). Bleeding tendency waѕ found in 15 patientѕ (100%), while abdominal pain waѕ found in 12 patientѕ (80%). Aѕ regardѕ other ѕymptomѕ, lower limb swelling and abdominal enlargement were noticed in 30% and 20% of patient reѕpectively, anemic manifeѕtationѕ and recurrent infectionѕ were noticed in 53% and 47% of patient reѕpectively. Poѕtembolization syndrome waѕ the moѕt common complication and occurred in all patientѕ (100%). Newly developed aѕciteѕ occurred in 2 patientѕ (13%). Ѕplenic abѕceѕѕ waѕ developed in 2 patientѕ (13%). No other complications had been reported. Conclusion: Partial splenic arterial embolization is an effective method for the treatment of thrombocytopenia resulting from hypersplenism in patients with liver cirrhosis; however, the procedure is associated with complications, and hence must be performed only if clearly indicated and by an expert person.

Microwave ablation in the spleen versus partial splenic artery embolisation: A new technique for hypersplenism in cirrhosis

Background and study aimsSplenectomy has been associated with high perioperative morbidity and mortality. Partial splenic artery embolisation (PSE) was found to be an effective and safer method but with numerous complications. Local thermal ablative techniques such as microwave ablation (MWA) have been tried and were found to be safe and effective alternatives. This randomised controlled study aimed to compare the efficacy and safety of MWA versus PSE in the treatment of hypersplenism in patients with post-hepatitis C cirrhosis. Patients and methodsIn total, 40 patients with post-hepatitis C cirrhosis complicated with hypersplenism were randomised into two groups: Group I: 20 patients treated with percutaneous MWA of splenic parenchyma under ultrasound guidance and Group II: 20 patients treated with PSE using Embosphere. ResultsThere was a significant increase in haemoglobin levels in group I compared with group II after 3months of follow-up. However, White blood cell (WBC) count and platelets significantly increased more in group II than in group I after 1month. Postprocedure significant hyperbilirubinaemia, hypoalbuminaemia, decreased prothrombin concentration, and increased creatinine levels were encountered in group II only. There was a significant increase in postoperative complications in group II compared to group I, and a single case of mortality was reported in group II. ConclusionMWA and PSE were comparably effective; however, MWA was safer than PSE, which caused serious adverse events and mortality. MWA appears to be a good alternative for the treatment of hypersplenism in patients with cirrhosis and portal hypertension.

Hypersplenism in patients with extrahepatic portal venous obstruction (EHO): Its correlation with splenomegaly and severity of portal hypertension

Hypersplenism in patients with extrahepatic portal venous obstruction (EHO): Its correlation with splenomegaly and severity of portal hypertension

Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series.

BACKGROUND:Splenectomy for the treatment of hypersplenism in patients with cirrhosis (HIC) is related with complications. Laparoscopic splenic artery ligation (LSAL) may be an alternative treatment option.AIMS:To evaluate safety and feasibility of LSAL in the treatment of HIC.PATIENTS AND METHODS:Retrospective analysis of prospectively collected data of ten patients with HIC who were treated with LSAL from October 2012 to February 2015.RESULTS:The median (range) age was 33.2 (13-56) years and sex distribution was equal. The median (range) leukocyte counts (×109/L) before, and at 3, 6 and 12 months after LSAL were 2.2 (0.8-8.2) and 5.65 (2.78-10.7), 4.7 (2.8-7.8) and 4.95 (3.4-7.7) respectively. The median (range) platelet counts (×109/L) before and at 3, 6 and 12 months after LSAL were 25.5 (11-65) and 75 (39-289), 74 (32-184) and 76 (56-251) respectively. Following LSAL, there was a significant improvement in total leucocyte count, platelet count and Model for End-Stage Liver Disease (MELD) score (P < 0.05). Two patients (20%) developed intraoperative bleeding and required conversion; one of these two patients developed splenic cyst that required radiological intervention. Four patients (40%) had post ligation syndrome (PLS) that was managed conservatively. During a median (range) follow-up of 19.5 (5-29) months, one patient (10%) required splenectomy due to inadequate response.CONCLUSION:LSAL is a safe and feasible treatment option for the palliation of symptomatic HIC, however, further prospective trials are necessary for confirmation.

Progress in treatment of hypersplenism in patients with post-hepatitis cirrhosis

Progress in treatment of hypersplenism in patients with post-hepatitis cirrhosis

Коррекция гиперспленизма у пациентов с хирургическими осложнениями портальной гипертензии

Коррекция гиперспленизма у пациентов с хирургическими осложнениями портальной гипертензии

Laparoscopic splenectomy for patients with liver cirrhosis: Improvement of liver function in patients with Child-Pugh class B

We aimed to assess the short-term outcomes of laparoscopic splenectomy (LS) and liver function at 1 year after splenectomy in the patients with liver cirrhosis. Forty-five patients with liver cirrhosis and hypersplenism underwent LS. We reviewed electronic medical records regarding the liver functional reserve, the etiology of liver cirrhosis, and the presence of hepatocellular carcinoma and esophago-gastric varices. Prospectively collected data of perioperative variables, postoperative complications, and long-term liver function were analyzed. Forty-five patients had a chronic liver disease classified into Child-Pugh classes (A/B/C: 23/20/2). The etiologies of disease were hepatitis C virus infection in 34 patients, hepatitis B virus infection in 4, and others in 7. Fourteen patients underwent procedures in addition to LS, including hepatectomy (n = 7) and devascularization for esophagogastric varices (n = 8). Postoperative complications occurred in 11 patients (24%). Neither postoperative liver failure nor in-hospital mortality occurred. White blood cell and platelet counts determined 7 days, 1 month, and 1 year after LS doubled or increased more than twice compared with the preoperative values (P < .001). One year after LS, patients who had been classified preoperatively into Child-Pugh class B had decreased total serum bilirubin levels (P = .03), and increased prothrombin activity (P = 003) and decreased Child-Pugh scores (P = .001). The Child-Pugh classifications improved in 14 of 18 patients (78%) who had Child-Pugh class B preoperatively. LS is a safe and feasible procedure for hypersplenism in patients with liver cirrhosis. In addition, LS most likely ameliorates liver function at 1 year after LS in patients with Child-Pugh class B liver cirrhosis.