Laparoscopic splenectomy: Outcomes and lessons learned from over 200 cases

Park, Adrian E.; Birgisson, Guðjón; Mastrangelo, Michael J.; Marcaccio, Michael; Witzke, Donald B.

doi:10.1067/msy.2000.109065

Cited by 121 publications

(86 citation statements)

References 14 publications

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“…Following splenectomy, the risk of symptomatic SPVT may be higher than that of DVT/PE. 9,13,25,31 From the results of our analysis it appears that there is no difference in the risk for postoperative SPVT after OS or LS. The main reasons for this finding may be that the mean operating time for LS is longer than that for OS, the damage to the splenic vein may be greater in LS and the pneumoperitoneum may induce venous stasis.…”

Section: Discussionmentioning

confidence: 73%

“…30 In studies with evaluation of symptomatic DVT/PE, the incidence was 1.6% (7/433). 9,13,25,31 It is uncertain whether in studies in which DVT/PE was not mentioned 11,12,21,24 the incidence was zero or if the incidence was not specifically evaluated. To date, it is impossible, from the available data, to draw any specific conclusions on the occurrence and prevention of DVT/PE after splenectomy.…”

Section: Incidence Of Deep Venous Thrombosis And/or Pulmonary Embolismentioning

confidence: 99%

“…The prophylactic antithrombotic strategies in the various cohorts or cases were extremely heterogeneous and ranged from no systemic prophylaxis, 6,32 only pneumatic compression 8,31 to subcutaneous standard or low molecular weight heparin (LMWH). 9,12,21,24 The duration of heparin prophylaxis ranged from three to more than seven days after surgery.…”

Section: Antithrombotic Prophylaxismentioning

confidence: 99%

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The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - an unresolved issue

Krauth¹,

Lechner²,

Neugebauer³

et al. 2008

Haematologica

122

103

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Patients undergoing splenectomy have an increased risk of splenic/portal vein thrombosis. We used several databases to identify publications dealing with this risk and analyzed incidence, risk factors and outcome. The risk of splenic portal vein thrombosis has been addressed in prospective and retrospective randomized or non-randomized studies. All studies combined, the overall risk is 3.3%. Risk factors are big spleens (i.e. myeloproliferative disorders) and hereditary hemolytic anemias, whereas the risk is low in autoimmune thrombocytopenia and trauma. The incidence is approximately the same in laparascopic and open splenectomy. The median time from splenectomy to symptomatic splenic vein thrombosis is 8-12 days. Postoperative antithrombotic prophylaxis ranged from no prophylaxis to heparin for seven days or longer. Treatment of symptomatic splenic vein thrombosis with heparin and warfarin leads to complete resolution of thrombosis in 67%, to partial resolution in 13%, but persistent occlusion, portal hypertension or cavernoma occurred in 20%. The long-term outcome of treatment failures is unknown. Well-designed randomized studies on the prophylaxis of venous thromboembolism after splenectomy are urgently needed.Key words: portal vein thrombosis, risk factors, splenectomy, thromboembolism, treatment. Citation: Krauth M-T, Lechner K, Neugebauer EAM and Pabinger I. The postoperative splenic/portal vein thrombosis after splenectomy and its prevention -an unresolved issue.

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Section: Discussionmentioning

confidence: 73%

Section: Incidence Of Deep Venous Thrombosis And/or Pulmonary Embolismentioning

confidence: 99%

Section: Antithrombotic Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - an unresolved issue

Krauth¹,

Lechner²,

Neugebauer³

et al. 2008

Haematologica

122

103

View full text Add to dashboard Cite

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“…Several large studies have demonstrated that LS is accepted as feasible and safe [5,11] and that it is associated with lower morbidity rates and faster recovery time compared to the conventional open technique [12]. While surgery is the definitive way to eradicate the clinically significant pathology of this illness, i.e., the tendency to bleed due to deficient platelets, it sometimes has to be performed in patients with very low platelet counts.…”

Section: Discussionmentioning

confidence: 99%

Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

2005

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Laparoscopic splenectomy (LS) is now performed routinely in patients with idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment. Low preoperative platelet count was deemed to be a contraindication for a laparoscopic approach; however, there is no data reporting the outcome in those patients. We aimed to evaluate the influence of the preoperative platelet count on the operative and postoperative course and complication rate. Retrospective cohort study that was conducted in tertiary care university-affiliated medical center and included 110 consecutive patients who underwent LS. All patients were divided into three groups by their preoperative platelet counts: £20 · 10 9 /L (n = 12), (20-50) · 10 9 /L (n = 18), and >50 · 10 9 /L (n = 80). The outcome and the influence of preoperative factors predictive of complications, blood transfusion, and length of stay were compared between the groups. Patients with a platelet count of £20 · 10 9 /L had a much longer hospital stay, received more blood transfusions, and suffered more complications than patients with platelet counts of (20-50) · 10 9 /L or higher (P < 0.05). Transfused patients had a longer hospital stay than non-transfused patients (2.08 vs. 6.4 days, P = 0.029). The strongest predictor for transfusion was the platelet count (odds ratio = 23, P = 0.008). LS in patients with very low platelet counts is feasible and reasonably safe, but the platelet count is a major determinant of morbidity. Every effort should be made to elevate platelet levels to >20 · 10 9 /L before surgery. Patients with counts >20 · 10 9 /L can safely undergo LS. Am. J. Hematol. 80:95-100, 2005. ª 2005 Wiley-Liss, Inc.

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“…Because he was generally in good medical condition previously with no special therapy or medication, a hematological malignancy that could cause marked atypical lymphocytosis seemed unlikely. In addition, the indication for the splenectomy was accidental trauma to his thorax, not a disease [9,10]. Accordingly, although atypical, we conclude that our patient indeed had a primary EBV infection, which resulted in a mononucleosis-like condition.…”

Section: Discussionmentioning

confidence: 87%

Epstein-Barr Virus Infectious Mononucleosis in a Splenectomized Patient

Kunimatsu

2013

J Med Cases

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The clinical picture in infectious mononucleosis (IM) consists primarily of pharyngitis, fever, and lymphadenopathy. IM is a common clinical syndrome. However, little attention has been paid to a clinical feature of IM that can occur in a previously splenectomized subject. Indeed, the clinical features of splenectomized patients with IM have not yet been fully described. Especially, in EpsteinBarr virus (EBV), to our knowledge, there is no report in the English language literature. We describe here an atypical IM case; an asplenic but healthy male presented with acute primary EBV infection. He was afebrile, there was an absence of lymphadenopathy, and there was relatively marked lymphocytosis in his peripheral blood. This case illustrates that an asplenic state can distort the typical clinical picture of EBV mononucleosis.

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Laparoscopic splenectomy: Outcomes and lessons learned from over 200 cases

Cited by 121 publications

References 14 publications

The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - an unresolved issue

The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - an unresolved issue

Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

Epstein-Barr Virus Infectious Mononucleosis in a Splenectomized Patient

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