The Impact of Concomitant Splenectomy on the Portal Pressure in Patients with Liver Cirrhosis

PURPOSE: Concomitant splenectomy in cirrhotic patients is known to ameliorate the tendency to bleed and it decreases the portal venous pressure (PVP). However, the direct measurement of the change in the PVP after concomitant splenectomy has not yet been reported. We tried to measure the change of the PVP before and after splenectomy. METHODS: From March 2000 to May 2006, 18 patients underwent anatomical liver resection with concomitant splenectomy. All the patients had liver cirrhosis, thrombocytopenia and/or esophageal varix. Through the 5 French feeding tube, which was inserted into the right gastroepiploic vein after laparotomy, we directly measured the PVP before and after splenectomy, and also under portal triad clamping (PTC). RESULTS: After splenectomy, the PVP decreased significantly from 261.11+/-45.87 mmH2O to 221.11+/-38.48 mmH2O (p<0.05). Under PTC, the PVP decreased significantly from 605.00+/-116.48 mmH2O to 513.89+/-70.56 mmH2O (p<0.05). CONCLUSION: Concomitant splenectomy in patients with liver cirrhosis resulted in a significant reduction of the PVP.

Concomitant Splenectomy during Hepatectomy in Patients with Liver Cirrhosis and Thrombocytopenia / 한국간담췌외과학회지

BACKGROUND/AIMS: Resection of hepatocellular carcinoma in patients with liver cirrhosis and thrombocytopenia is risky. The benefit of concomitant splenectomy in cirrhotic patients is controversial. METHODS: To evaluate the efficacy of concomitant splenectomy in patients with liver cirrhosis and thrombocytopenia, 13 cirrhotic patients with thrombocytopenia (platelet count< or =80,000/mm3) were divided by two groups (Group I: the patients without concomitant splenectomy during hepatectomy, Group II: the patients with concomitant splenectomy). Intraoperative and postoperative parameters were retrospectively reviewed. RESULTS: Group II patients needed less amount of postoperative blood transfusion (Group I: 178.3+/-150 ml PRC in 3 patients, Group II: 107.1+/-100 ml in 2 patients, p=0.012, p= 0.041) and the platelet count was elevated to above 250,000/mm3 (p=0.003) and showed lower serum bilirubin level (p=0.037) within 1 week of operation in group II patients. CONCLUSION: The concomitant splenectomy during in patients of liver cirrhosis with thrombocytopenia may improve liver function and elevate platelet count.