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2001 Abstract: 2468 Prophylactic Splenectomy for Asymptomatic Splenic Vein Thrombosis During Resection for Chronic Pancreatitis

2001 Digestive Disease Week

# 2468 Prophylactic Splenectomy for Asymptomatic Splenic Vein Thrombosis During Resection for Chronic Pancreatitis
Frank Makowiec, Ulrich Adam, Stefan Liebe, Ulrich T. Hopt, Rostock, Germany

Background Chronic pancreatitis (CP) is the leading cause of splenic vein thrombosis (SVT). Splenic vein thrombosis occurs in about 15 % of all patients with CP and in about 10 % in CP of the pancreatic head. The risk of gastric variceal bleeding in SVT is reported to be approximately 10-15%. In symptomatic SVT (bleeding, thrombocytopenia, leucopenia) splenectomy is the treatment of choice but its role in asymptomatic SVT is discussed controversially. Aim of our study was to evaluate the peri- and postoperative outcome of splenectomy performed during otherwise indicated resection in patients with CP and asymptomatic SVT.

Methods Between March 1995 and March 2000 216 pancreatic resections were performed for CP. Twenty-two patients had preoperatively documented asymptomatic SVT and underwent splenectomy during pancreatic resection (14 head, 8 distal). Seven patients had gastric varices and 18 had intraoperatively confirmed left-sided portal hypertension. Peri- and postoperative follow-up data were analyzed to evaluate possible risks and benefits of splenectomy.

Results Intraoperative complications due to splenectomy did not occur. In 8 of 22 (36%) cases difficulties (mainly bleeding) due to left-sided portal hypertension before accomplishing splenectomy were noted. Postoperative complications occured in 6 of 22 (27%) patients. Five complications not due to splenectomy were treated conservatively or interventionally. One bleeding after splenectomy led to the only relaparotomy (complication rate of splenectomy: 5%). During follow-up we could not document any case of postsplenectomy sepsis or thrombosis due to temporary thrombocytosis.

Conclusion Complications of prophylactic splenectomy are rare and less frequent than episodes of variceal bleeding. In the presence of an asymptomatic SVT prophylactic splenectomy should be considered during pancreatic resection for CP to facilitate surgery and to avoid potential variceal bleeding.

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