Laparoscopic Splenectomy in Non-Cirrhotic Portal Hypertension- A Retrospective Analysis of a Prospectively Performed Series

Abstract

In our institute, laparoscopic splenectomy was performed in 27 patients over a period of 7 years for two major indications: hypersplenism and refractory variceal bleeding. 19 patients had Extra Hepatic Portal Venous Obstruction (EHPVO) and 8 patients had Non-Cirrhotic Portal Fibrosis ( NCPF). All the patients had hypersplenism, with thrombocytopenia( < 50,000/cu.mm),leukopenia (< 4000/Cu mm)as well in 9 (33% )of the patients, and anemia ( Hb<10gm) in 8(30%) . Variceal bleeding requiring Endoscopic Variceal Ligation (EVL) were found in 23 patients,17 in the EHPVO group and 6 in the NCPF group . 4 patients were females and 23 were male. The age range was from 12 to 37 years, the mean being 24 years. The laparoscopic procedure was successful in 25, but 2 patients needed conversion to left subcostal laparotomy because of extensive and giant collaterals around the hilum of the spleen; these conversions happened in the first three years of our laparoscopic splenectomy experience, with no conversions in the subsequent 4 years. Even in the presence of a relative contraindication like portal hypertension, laparoscopic splenectomy is still a viable proposition in the vast majority of cases. Technical considerations , like deployment of powerful energy sources, vascular staplers and preliminary splenic artery ligation are discussed in this article.