Efficacy And Safety Of Laparoscopic Splenectomy For Hypersplenism Secondary To Portal Hypertension After Transjugular Intrahepatic Portosystemic Shunt

BackgroundLaparoscopic splenectomy(LS)being used after Transjugular intrahepatic portosystemic shunt(TIPS)has not been reported.This report aims to explore the feasibility,safety,and potential efficacy of LS after TIPS hypersplenism secondary to portal hypertension.MethodsThis study is a retrospective analysis,including 6 patients who underwent LS after TIPS(TIPS+LS group)and 12 patients who accepted TIPS alone(TIPS group).ResultsThere was no statistical difference of the 5-year cumulative stent patency rate(57%vs 40%,p=0.941)and the 5-year cumulative portal vein thrombosis rate(34.5%vs 25%,p=0.508)between the TIPS group and the TIPS+LS group.The linear mixed model analyses showed that the platelet count of the TIPS+LS group were 107.2 × 109/L(95%CI:73.0-141.5,p<0.001)higher than that of the TIPS group,and the white blood cell count 3.18 x 109/L(95%CI:2.00～4.37,p<0.001)higher.The prothrombin activity,prothrombin time,activated prothrombin time,and international normalized ratio indexes were improved after LS in the TIPS+LS group.During the follow-up period,no severe adverse events occurred in both groups.ConclusionLS following TIPS is feasible,safe,and beneficial for patients with hypersplenism secondary to portal hypertension.The following LS not only corrects the hypersplenism,but also has the potential to improve liver function.