2005 Abstracts: Clinical Significance of Laparoscopic Splenectomy for Hypersplenism of Liver Cirrhosis
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Clinical Significance of Laparoscopic Splenectomy for Hypersplenism of Liver Cirrhosis
HIROFUMI KAWANAKA, Department od Surgery and Science, Kyushu University, Fukuoka, Fukuoka, Japan; Morimasa Tomikawa, Deparment of Surgery and Science, Kyushu University, Fukuoka, Fukuoka, Japan; Shohei Yamaguchi, Nao Kinjo, Department of Surgery and Science, Kyushu University, Fukuoka, Fukuoka, Japan; Daisuke Yoshida, Department of disaster and emergency medicine, Kyushu University, Fukuoka, Fukuoka, Japan; Kouzou Konishi, Department of surgery and science, Kyushu University, Fukuoka, Fukuoka, Japan; Kazuo Tanoue, Department of Surgery and Science, Fukuoka, Fukuoka, Japan; Makoto Hashizume, Department of disaster and emergency medicine, Kyushu University, Fukuoka, Fukuoka, Japan; Yoshihiko Maehara, Department of surgery and science, Kyushu University, Fukuoka, Fukuoka, Japan
Background: Laparoscopic splenectomy (LS) is widely accepted as a treatment for hematological disorders such as ITP. However, it remains controversial that LS could be safely performed in liver cirrhosis, because of its bleeding tendency and development of collateral vessels. In this study, we aimed to evaluate the safety and clinical significance of the procedure for hypersplenism due to liver cirrhosis.
Patients & Methods: From June1994 to September 2004, 110 cirrhotic patients with hypersplenism underwent LS. First, to determine the safety and efficacy of LS, we compared the results of LS in cirrhotic patients (n=110; LS group) with those of conventional open splenectomy in cirrhotic patients at the same period (n=20; OS group). Next, we evaluated the clinical significance of LS in liver cirrhosis. The indications for LS were bleeding tendency due to thrombocytopenia (n=57), difficulty in receiving treatment for hepatocellular carcinoma (HCC) due to thrombocytopenia (n=38), and sclerotherapy-resistant esophagogastric varices (n=32). Results: (1) There was no death related to the operation in both groups. The average operation time was 258 and 276 min in LS and OS group, respectively (p=0.61). The average blood loss was as low as 352mL in LS group, compared with 1600mL in OS group (p < 0.01). The average hospital stay was shortened to 15.7 days in LS group, compared to 24.0 in OS group (p< 0.01). The ingestion started 1.5 days and 3.0 days after the operation, in LS and OS group, respectively (p < 0.05). (2) Although the average preoperative platelet count was 4.7×104/mm3, it had been maintained at over 10.0×104/mm3 for over three years. After the operation, total bilirubin level was significantly improved from 1.4mg/dL to 1.1 mg/dL and prothrombin time was significantly increased from 56% to 68%. Thirty-two patients with HCC successfully underwent treatment for HCC such as chemotherapy, PEIT and ablation therapy by the increase in the platelet count. Six patients could receive the interferon therapy for hepatitis C after the operation. So far, there has been no recurrence of esophagogastric varices. Conclusions: A laparoscopic splenectomy is likely to be a safe and effective procedure even in liver cirrhosis and it also impacts on the strategy for treatment of disorders related to liver cirrhosis.
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