Evaluation of Three Methods of Treatment of Hypersplenism

Abstract

This study was conducted for evaluation of safety, efficacy and complications of using open splenectomy, splenic artery embolization and laparoscopic splenectomy in treating hypersplenism. The study included 35 patients; 20 males and 15 females with mean age of 46 years with hypersplenism. They were admitted at General Surgery Department, Zagazig University over a period between 2013 and 2015. All patients were subjected to thorough history taking, clinical examination, full laboratory investigations, upper gastrointestinal endoscopy, abdominal ultrasound and duplex scan. They were divided into three groups according to line of management. Group I patients were treated by open splenectomy, while group II patients were treated by Partial splenic artery embolization (PSE) and group III patients were treated by laparoscopic splenectomy. In group I, there was one mortality recorded due to uncontrollable intraoperative bleeding and also one mortality in group III due to gastric fisula, while in group II, no mortality was recorded. PSE was a significant, rapid procedure and had shorter hospital stay and no blood transfusion was needed, while group I and group III had longer hospital stay and need blood transfusion. Marked improvement in platelet and leucocyte counts occurred in group I and group III and remained at normal level during follow-up period. In group II, there was improvement of platelets and leucocytes but not marked as groups I and III and there was a slight decrease in platelet count during follow-up period but not decrease as pre-embolization period. Liver function tests were normal during follow-up period in most cases in groups I and III as most cases were Child A. In group II patients, liver function tests were elevated during follow up as most cases were Child B. In group I, 13 patients had postoperative fever (> 39°C) due to chest and wound infection, one patient had asymptomatic portal vein thrombosis and one patient had incisional hernia treated by hernioplasty and one patient had splenic bed collection was treated by Apocath insertion and one patient developed ascites during follow-up period treated by liver support. Pancreatitis and OPSI did not occur in our patients. In group II, 11 patients had postoperative fever (>38°C) treated by NSAID, three patients had ascites and one patient developed splenic abscess was treated by splenectomy with good outcome, and one patient had recurrence post-embolization. In group III, three patients were converted to open splenectomy due to intraoperative bleeding and lack of experience of the surgeon and one patient was completed till the end of operation laparoscopically, one patient died during follow up due to gastric fistula. Our study shows that laparoscopic splenectomy is a good operation for ITP patients, but still needs more training, more experience and more cases to improve the results.