Effect of Laparoscopic Splenectomy on Portal Hypertensive Gastropathy in Cirrhotic Patients With Portal Hypertension

Effect of Laparoscopic Splenectomy and Portal Hypertensive Gastropathy

Go Anegawa; Hirofumi Kawanaka; Hideo Uehara; Tomohiko Akahoshi; Kozo Konishi; Daisuke Yoshida; Nao Kinjo; Naotaka Hashimoto; Morimasa Tomikawa; Makoto Hashizume; Yoshihiko Maehara

Disclosures

J Gastroenterol Hepatol. 2009;24(9):1554-1558. 

In This Article

Results

Prevalence of PHG

At first endoscopy, PHG was observed in 49 out of 70 patients. It was mild in 32 and severe in 17 patients. The characteristics of the patients with and without PHG are reported in Table 1. Patients with PHG had more severe signs of portal hypertension: the resected spleen volume (P < 0.0001) and the presence of esophageal varices (P < 0.01) more frequently coexisted with PHG. Multivariate analysis showed that the resected spleen volume, total bilirubin and hemoglobin are independent risk factors for PHG (Table 2). As shown in Figure 1 and 2, the prevalence of PHG correlated with the duration and severity of liver disease and the resected spleen volume.

Figure 1.

The relationship between the Child-Pugh Score and portal hypertensive gastropathy (PHG). The prevalence of PHG correlates with the duration and severity of liver disease. Results are expressed as mean ± standard deviation. *P < 0.05; none versus mild, none versus severe PHG.

Figure 2.

Relationship between resected spleen volume and portal hypertensive gastropathy (PHG). Prevalence of PHG correlated with resected spleen volume. Results are expressed as mean ± standard deviation. *P < 0.05; none versus mild, mild versus severe PHG.

Operative Findings

Seventy laparoscopic splenic procedures were performed. Two (2.8%) required conversion to open surgery because of bleeding. Operative time was a mean 230 ± 62 min, and mean blood loss was 216 ± 190 g (Table 3).

Endoscopic Findings of PHG Before and After Laparoscopic Splenectomy

To determine whether laparoscopic splenectomy improved PHG in patients with liver cirrhosis and portal hypertension, we evaluated the endoscopic findings of PHG. Among 49 patients with PHG, 17 had severe PHG and 32 had mild PHG. After laparoscopic splenectomy, PHG was significantly improved: in seven patients, severe PHG was reduced to none; in nine patients, severe PHG was reduced to mild PHG; and in 12 patients, mild PHG was reduced to none (Figure 3).

Figure 3.

Endoscopic findings of portal hypertensive gastropathy (PHG) before and after laparoscopic splenectomy. After laparoscopic splenectomy, PHG was significantly improved: in seven patients, severe PHG was reduced to none; in nine patients, severe PHG was reduced to mild; and in 12 patients, mild PHG was reduced to none (according to the classification by McCormack). P < 0.0001; before versus after splenectomy.

Effect of Laparoscopic Splenectomy on Liver Function

In patients undergoing laparoscopic splenectomy, platelet and white blood cell (WBC) counts, serum albumin level, and prothrombin activity all showed a significant increase. The serum total bilirubin level showed a significant decrease. The Child-Pugh score showed a significant improvement after laparoscopic splenectomy (Table 4).

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