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High Incidence of Thrombosis of the Portal Venous System After Laparoscopic Splenectomy: A Prospective Study With Contrast-Enhanced CT Scan

Ikeda, Masataka MD, PhD*; Sekimoto, Mitsugu MD, PhD*; Takiguchi, Shuji MD*; Kubota, Masaru MD*; Ikenaga, Masakazu MD, PhD*; Yamamoto, Hirofumi MD, PhD*; Fujiwara, Yoshiyuki MD, PhD*; Ohue, Masayuki MD, PhD*; Yasuda, Takushi MD, PhD*; Imamura, Hiroshi MD, PhD; Tatsuta, Masayuki MD, PhD; Yano, Masahiko MD, PhD*; Furukawa, Hiroshi MD, PhD; Monden, Morito MD, PhD*

doi: 10.1097/01.sla.0000151794.28392.a6

Objective: The aims of this prospective study were to investigate the true incidence of portal or splenic vein thrombosis (PSVT) after elective laparoscopic splenectomy using contrast-enhanced computed tomography (CT) scan, and outcome of anticoagulant therapy for PSVT.

Summary Background Data: Although rare, thrombosis of the portal venous system is considered a possible cause of death after splenectomy. The reported incidence of ultrasonographically detected PSVT after elective open splenectomy ranges from 6.3% to 10%.

Methods: Twenty-two patients underwent laparoscopic splenectomy (LS group), and 21 patients underwent open splenectomy (OS group). Preoperative and postoperative helical CT with contrast were obtained in all patients, and the extent of thrombosis was investigated. Prothrombotic disorder was also determined.

Results: PSVT occurred in 12 (55%) patients of the LS group, but in only 4 (19%) of the OS group. The difference was significant (P = 0.03). Clinical symptoms appeared in 4 of the 12 LS patients. Thrombosis occurred in the intrahepatic portal vein (n = 9), extrahepatic portal vein (n = 2), mesenteric veins (n = 1), proximal splenic vein (n = 4), and distal splenic vein (n = 8). Prothrombotic disorder was diagnosed in 1 patient. Anticoagulant therapy was initiated once the diagnosis was established, and complete recanalization, except for distal splenic vein, was observed without any adverse event. Patients with splenomegaly were at high risk of PSVT.

Conclusions: PSVT is a more frequent complication of laparoscopic splenectomy than previously reported but can be treated safely following early detection by CT with contrast.

This study compares the incidence of portal or splenic vein thrombosis (PSVT) after elective laparoscopic splenectomy (LS) using contrast-enhanced CT scan with open splenectomy (OS). PSVT occurred in 55% patients with LS, and the incidence of PSVT after LS was significantly higher than that after OS. Anticoagulant therapy was effective.

From the *Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Suita, Japan; and †Department of Surgery, Sakai Municipal Hospital, Sakai, Japan.

Reprints: Masataka Ikeda, MD, PhD, Department of Surgery and Clinical Oncology (E2), Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 565-0871, Japan. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.