SSAT - Impact of Laparoscopic Splenectomy for Hypersplenism in Cirrhotic Patients on Long-Term Liver Function

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Impact of Laparoscopic Splenectomy for Hypersplenism in Cirrhotic Patients on Long-Term Liver Function
Naoki Yamamoto^*, Keiichi Okano, Yausyuki Suzuki

Gastroenterological surgery, Kagawa University, Kitagun, Japan

Background This study aimed to assess effectiveness of laparoscopic splenectomy (LS) on hypersplenism and short and long-term liver function for cirrhotic patients.
Methods From February 2008 to March 2013, forty-five patients (Child-Pugh A/B/C:23/20/2) with cirrhosis and hypersplenism underwent LS at a single institution. The etiologies of cirrhosis were hepatitis C virus (HCV) in 34, hepatitis B virus (HBV) in 4, and other diseases in 7 patients. Perioperative results, complications and liver function after LS were analyzed.
Results A total of 45 patients (27 male and18 females) underwent LS. Fourteen patients received additional procedures including hepatectomy (n= 7) or esophagogastric devascularization (n=7). Four patients required conversion to open surgery because of severe adhesion and bleeding. Median operation time was 215 minutes (range 111-325) and median estimated blood loss was 184ml (range 20-2061). Median hospital stay was 13 days (range7-41).Postoperative complications ( Clavien-dindoⅡ< ) were portal vein thrombosis (PVT, n=8), infection (n=3), bleeding(n=1), and , ascites (n=1). There was no in-hospital mortality and liver failure. WBC and PLT counts at 7days, 1 month and 1year after LS were significantly higher compared with preoperative value(p<0.001), respectively.
In patients with Child Bclassification , serum total bilirubin level and Child-Pugh score were significantly decrease (p<0.05)) and prothrombin time were increase (p=0.003) compared with preoperative value at 1 year after LS . Child-Pugh classification was improved in 14 of 20patients with Child B (70%).
Conclusion LS was a safe and feasible procedure for hypersplenism with liver cirrhosis. In addition, LS was effective for improvement of long-term liver function in patients with Child B classification.

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