Skip to main content
SpringerLink
Log in

Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Minimally invasive splenectomy is now well established for a wide range of pathologies. Portal vein thrombosis (PVT) is increasingly being recognised as a complication of splenectomy. The aim was to determine the incidence and risk factors for PVT after laparoscopic splenectomy.

Methods

All cases of elective laparoscopic splenectomy performed from 1993 to 2020 were reviewed. Parameters recorded included demographics, diagnostic criterion and post-operative outcomes. Data were analysed using Minitab V18 with a p < 0.05 considered significant.

Results

210 patients (103 female, 107 male) underwent laparoscopic splenectomy (14 to 85 years). A major proportion of cases were performed for ITP (n = 77, p = 0.012) followed by lymphoma (n = 28), indeterminate lesions (n = 21) and myelofibrosis (n = 19). Ten patients developed symptomatic portal vein thrombosis (4.8%). Patients presented most commonly with pain and fever and diagnosis was confirmed by computed tomography (CT) or ultrasonography (USS). There were 10 conversions (4.8%) to open and two postoperative deaths, one from PVT and one from pneumonia. The remaining nine patients were successfully treated with anticoagulation. Of 19 patients with myelofibrosis, six patients developed PVT (p = 0.0002). Patients who developed PVT had significantly greater specimen weights (1773 g vs 348 g, p < 0.001). Forty-three patients had a specimen weight of 1 kg or greater, and of these 9 developed portal vein thrombosis (21%), versus one with PVT of 155 with a specimen weight of less than 1 kg (p < 0.0001). Myelofibrosis (p = 0.0039), specimen weight (p < 0.001) and mean platelet count (p = 0.0049) were predictive of PVT.

Conclusion

A high index of suspicion for this complication should be maintained and prompt treatment with anticoagulation. High-risk patients should be considered for prophylactic anticoagulation and routine imaging of the portal vein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rieg S, Bechet L, Naujoks K, Hromek J, Lange B et al (2020) A single-center prospective cohort study on postsplenectomy sepsis and its prevention. Open Forum Infect Dis. https://doi.org/10.1093/ofid/ofaa050

    Article  PubMed  PubMed Central  Google Scholar 

  2. Misiakos EP, Bagias G, Liakakos T, Machairas A (2017) Laparoscopic splenectomy: current concepts. World J Gastrointest Endosc 9(9):428–437. https://doi.org/10.4253/wjge.v9.i9.428

    Article  PubMed  PubMed Central  Google Scholar 

  3. Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, O’Rourke N, Nathanson L, Fielding G (2003) Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 238(2):235–240. https://doi.org/10.1097/01.sla.0000080826.97026.d8.PMID:12894017;PMCID:PMC1422687

    Article  PubMed  PubMed Central  Google Scholar 

  4. van’t Riet M, Burger WA, van Muiswinkel JM, Kazemier G, Schipperus MR et al (2000) Diagnosis and treatment of portal vein thrombosis following splenectomy. Br J Surg 87:1229–1233

    Article  Google Scholar 

  5. Hassn AMF, Al-Fallouji MA, Ouf TI, Saad R (2000) Portal vein thrombosis following splenectomy. Br J Surg 78:362–373

    Google Scholar 

  6. Chaffanjon PCJ, Brichon PY, Ranchoup Y, Gressin R, Sotto JJ (1998) Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging. World J Surg 22:1082–1086

    Article  CAS  Google Scholar 

  7. Petit P, Bret P, Atri M, Greno A, Casola G, Gianfelice D (1994) Splenic vein thrombosis after splenectomy: frequency and role of imaging. Radiology 190:65–68

    Article  CAS  Google Scholar 

  8. Skarsgard E, Doski J, Jaksic T, Wesson D, Shandling B et al (1993) Thrombosis of the portal venous system after splenectomy for pediatric hematologic disease. J Pediatr Surg 28(9):1109–1112

    Article  CAS  Google Scholar 

  9. Miniati DN, Padidar AM, Kee ST, Krummel TM, Mallory B (2005) Portal vein thrombosis after laparoscopic splenectomy: an ongoing clinical challenge. JSLS 9(3):335–338

    PubMed  PubMed Central  Google Scholar 

  10. Winslow ER, Brunt LM, Drebin JA, Soper NJ, Klingensmith ME (2002) Portal vein thrombosis after splenectomy. Am J Surg 184:631–636

    Article  Google Scholar 

  11. Condat B, Pessione F, Denninger MH, Hillaire S, Valla D (2000) Recent portal or portal vein thrombosis: increased recognition and frequent recanalisation on anticoagulant therapy. Hepatology 32:466–470

    Article  CAS  Google Scholar 

  12. Wu M, Schuster M, Tadros M (2019) Update on management of portal vein thrombosis and the role of novel anticoagulants. J Clin Transl Hepatol 7(2):154–164

    PubMed  PubMed Central  Google Scholar 

  13. Faccia M, Ainora ME, Ponziani FR, Riccardi L, Garcovich M et al (2019) Portal vein thrombosis in cirrhosis: why a well-known complication is still matter of debate. World J Gastroenterol 25(31):4437–4451

    Article  CAS  Google Scholar 

  14. Kinjo N, Kawanaka H, Akahoshi T, Tomikawa M, Yamashita N et al (2010) Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg. https://doi.org/10.1002/bjs.7002

    Article  PubMed  Google Scholar 

  15. Jiang G, Bai D, Chen P, Qian J, Jin S et al (2016) Risk factors for portal vein system thrombosis after laparoscopic splenectomy in cirrhotic patients with hypersplenism. J Laparoendosc Adv Surg Tech 26(6):419–423

    Article  Google Scholar 

  16. Qian Y, Li K (2017) The early prevention and treatment of PVST after laparoscopic splenectomy: a prospective cohort study of 130 patients. Int J Surg 44:147–151

    Article  Google Scholar 

  17. Huang D, Tao M, Cao L, Wang X, Zheng S et al (2019) Risk factors and anticoagulation effects of portal vein system thrombosis after laparoscopic splenectomy in patients with or without cirrhosis. Surg Laparosc Endosc Percutaneous Tech 29:498–502

    Article  Google Scholar 

  18. Krauth MT, Lechner K, Neugebauer EAM, Pabinger I (2008) The postoperative splenic/portal vein thrombosis after splenectomy and its prevention – an unresolved issue. Haematologica 93(8):1227–1232

    Article  Google Scholar 

  19. Fumihiko F, Lyass S, Otsuka K, Giordano L, Rosenbaum DL et al (2003) Portal vein thrombosis following splenectomy: identification of risk factors. Am Surg 69(11):951–956

    Google Scholar 

  20. Harris W, Marcaccio M (2005) Incidence of portal vein thrombosis after laparoscopic splenectomy. Can J Surg 48(5):352–354

    PubMed  PubMed Central  Google Scholar 

  21. Tsamalaidze L, Stauffer JA, Brigham T, Asbun HJ (2018) Postsplenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv): a single institutional series, comprehensive systematic review of a literature and suggested classification. Am J Surg 216(6):1192–1204

    Article  Google Scholar 

  22. Ikeda M, Sekimoto M, Takiguchi S et al (2005) High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg 241(2):208–216

    Article  Google Scholar 

  23. Soyer T, Ciftci AO, Tanyel FC, Senocak ME, Buyukpamukcu N (2006) Portal vein thrombosis after splenectomy in pediatric hematologic disease: risk factors, clinical features, and outcome. J Pediatr Surg 41(11):1899–1902

    Article  Google Scholar 

  24. Shibahara K, Tatsuta K, Orita H, Yonemura T, Kohno H (2007) Superior mesenteric and portal vein thrombosis caused by congenital antithrombin III deficiency: report of a case. Surg Today 37(4):308–310

    Article  Google Scholar 

  25. Morbieu C, Brunetti F, Baranès L, Languille L, Limal N, Loustau V, Bierling P, Michel M, Godeau B, Mahévas M (2015) Portal or splenic vein thrombosis after splenectomy for immune cytopenia: a retrospective cohort study. Blood 126(23):3483

    Article  Google Scholar 

  26. Zhang X, Wang Y, Yu M, Huang J, Deng D, Xue H (2017) Effective prevention for portal venous system thrombosis after splenectomy: a meta-analysis. J Laparoendosc Adv Surg Tech 27:247–252

    Article  Google Scholar 

  27. Rhee RY, Gloviczki P, Mendonca CT, Petterson TM, Serry RD, Sarr MG, Johnson CM, Bower TC, Hallett JW, Cherry KJ (1994) Portal vein thrombosis: still a lethal disease in the 1990s. J Vasc Surg 20:688–697

    Article  CAS  Google Scholar 

  28. Hall TC, Garcea G, Metcalfe M et al (2011) Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review. World J Surg 35:2510–2520

    Article  CAS  Google Scholar 

  29. Fujita F, Lyass S, Otsuka K et al (2003) Portal vein thrombosis following splenectomy: identification of risk factors. Am Surg 69:951–956

    PubMed  Google Scholar 

  30. Boxer MA, Braun J, Ellman L (1978) Thromboembolic risk of postsplenectomy thrombocytosis. Arch Surg 113:808–809

    Article  CAS  Google Scholar 

  31. Valla D, Casadevall N, Huisse MG, Tulliez M, Grange JD et al (1988) Etiology of portal vein thrombosis in adults: a prospective evaluation of primary myeloproliferative disorders. Gastroenterology 94:1063–1069

    Article  CAS  Google Scholar 

  32. Robertson DAF, Simpson FG, Losowsky MS (1981) Blood viscosity after splenectomy. Br Med J 283:573–575

    Article  CAS  Google Scholar 

  33. Kumar A, Sharma P, Arora A (2015) Review article: portal vein obstruction–epidemiology, pathogenesis, natural history, prognosis and treatment. Aliment Pharmacol Ther 41:276

    Article  CAS  Google Scholar 

  34. Mudireddy M, Gangat N, Lasho TL, Finke C, Hanson CA et al (2017) Early thrombotic events following splenectomy for myelofibrosis: incidence, risk factors and effect of pre-emptive anticoagulant therapy. Blood 130(Supplement 1):2921

    Google Scholar 

  35. Fujita F, Lyass S, Otsuka K, Giordano L, Rosenbaum DL, Khalili TM, Phillips EH (2003) Portal vein thrombosis following splenectomy: identification of risk factors. Am Surg 69(11):951–6

  36. Szasz P, Ardestani A, Shoji BT, Brooks DC, Tavakkoli A (2020) Predicting venous thrombosis in patients undergoing elective splenectomy. Surg Endosc 34(5):2191–2196. https://doi.org/10.1007/s00464-019-07007-2

Download references

Funding

None.

Author information

Author notes

  1. Benjamin Swinson and Peadar S. Waters co-first authors

Authors and Affiliations

  1. Department of Surgery, Royal Brisbane and Women’s Hospital, Herston, QLD, 4029, Australia

    Benjamin Swinson, Peadar S. Waters, Laurence Webber, Les Nathanson, David J. Cavallucci, Nicholas O’Rourke & Richard D. Bryant

  2. Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia

    Les Nathanson, David J. Cavallucci & Nicholas O’Rourke

  3. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

    David J. Cavallucci, Nicholas O’Rourke & Richard D. Bryant

  4. St Vincent’s Northside Medical Centre, St Vincent’s Private Hospital Northside, 627 Rode Road, Chermside, QLD, 4032, Australia

    Richard D. Bryant

Authors
  1. Benjamin Swinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peadar S. Waters
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laurence Webber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Les Nathanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David J. Cavallucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicholas O’Rourke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard D. Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peadar S. Waters.

Ethics declarations

Disclosures

Benjamin Swinson, Peadar S. Waters, Laurence Webber, Les Nathanson, David J. Cavallucci, Nicholas O’Rourke, Richard D. Bryant have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swinson, B., Waters, P.S., Webber, L. et al. Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors. Surg Endosc 36, 3332–3339 (2022). https://doi.org/10.1007/s00464-021-08649-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08649-x

Keywords

Search

Navigation