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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Published on: November 15, 2024

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A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopic splenectomy and

Zhe Cheng1, Fan Yu, Ju Tian

  • 1Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Gaotanyan Road 29#, Shapingba District, Chongqing, 400038, China.

Journal of Thrombosis and Thrombolysis
|February 21, 2015
PubMed

Insights

Early use of low molecular weight heparin (LMWH) significantly reduces portal vein system thrombosis (PVST) after laparoscopic surgery for cirrhosis and portal hypertension. This safe and effective approach improves patient outcomes by lowering complication rates.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Cirrhosis and portal hypertension (PH) are prevalent in China.
  • Laparoscopic splenectomy and esophagogastric devascularization (LS + ED) is an effective treatment for PH.
  • Portal vein system thrombosis (PVST) is a significant complication following LS + ED, with higher rates compared to open surgery.

Purpose of the Study:

  • To evaluate the efficacy and safety of early low molecular weight heparin (LMWH) for preventing PVST after LS + ED.
  • To compare early LMWH prophylaxis with conventional anticoagulant therapy in patients with cirrhosis and PH undergoing LS + ED.

Main Methods:

  • Retrospective analysis of 219 patients with cirrhosis and PH undergoing LS + ED from January 2008 to June 2013.
  • 139 patients received early LMWH therapy; 80 patients received conventional anticoagulant therapy.
  • Comparison of PVST rates and types, coagulation function, intra-abdominal bleeding, and esophagogastric variceal bleeding (EGVB) between the two groups.

Main Results:

  • The rate of postoperative PVST was significantly lower in the early LMWH group (30.2%) compared to the conventional group (50.0%) (P = 0.004).
  • Main trunk thrombosis rates were significantly reduced with early LMWH (1.4% vs. 15.0%, P = 0.000).
  • Esophagogastric variceal bleeding (EGVB) rates were also significantly lower in the early LMWH group (P = 0.048), with similar perioperative coagulation function and bleeding rates.

Conclusions:

  • Early anticoagulation with LMWH is a safe and effective strategy for preventing PVST in patients undergoing LS + ED for cirrhosis and PH.
  • This approach significantly reduces the incidence of PVST and related complications like EGVB.
  • LMWH prophylaxis offers a promising standard of care for managing PVST risk in this patient population.

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