Related Experiment Video
Updated: Sep 26, 2025
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Partial splenectomy in children undergoing liver transplantation or venous shunt for severe hypersplenism: A case
Olivier Boillot1, Sophie Chopinet2, Emilie Gregoire2
1Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; University Claude Bernard Lyon 1, France; Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Department of General Surgery and Liver Transplantation, la Timone Hospital, Marseille, France.
Insights
Partial splenectomy (PS) effectively treats hypersplenism and splenomegaly in children undergoing liver transplantation or venous shunt procedures. This intervention leads to significant improvements in platelet and white blood cell counts with lasting spleen size reduction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hematology
Background:
- Hypersplenism and splenomegaly in children often result from portal hypertension secondary to cirrhosis or portal cavernoma.
- Partial splenectomy (PS) is considered as a therapeutic option to manage persistent hypersplenism post-liver transplantation (LT) or venous shunt (VS).
Purpose of the Study:
- To retrospectively evaluate the efficacy and outcomes of partial splenectomy (PS) in pediatric patients with hypersplenism.
Main Methods:
- Retrospective analysis of 16 children undergoing PS combined with LT or VS between 1996 and 2020.
- Evaluation of hypersplenism reversion, durability, postoperative outcomes, and spleen size/volume changes.
- Comparison with a control group that did not undergo PS.
Main Results:
- Significant improvement in mean platelet and white blood cell counts within one month post-PS (P < 0.0001 and P = 0.001, respectively).
- Marked reduction in spleen length and volume (P < 0.0001 and P = 0.0003, respectively).
- 14 out of 16 patients survived with normalized blood counts and reduced spleen size after a mean follow-up of 92.6 months.
Conclusions:
- Partial splenectomy is an effective treatment for pediatric hypersplenism and splenomegaly in conjunction with LT or VS.
- PS demonstrates favorable outcomes without compromising the overall prognosis in these pediatric patients.
Background And Aim:
Hypersplenism is a consequence of portal hypertension and splenomegaly secondary to cirrhosis or portal cavernoma in children. In order to avoid persistent hypersplenism and splenomegaly after liver transplantation (LT) or venous shunt (VS), partial splenectomy (PS) may represent a relevant therapeutic option. The aim of this retrospective study was to evaluate the results of PS performed in children presenting hypersplenism.
Methods:
The following end-points were evaluated: (1) reversion of hypersplenism and its durability over time, (2) postoperative outcome, (3) courses of spleen size and volume and (4) comparison to a control group in which PS was not performed.
Results:
Between 1996 and 2020, 16 children underwent PS associated with LT (8 cases) for cirrhosis or VS (8 cases) for portal cavernoma. From Day 0 to 1 month, mean platelet and white blood cell counts (WBC) dramatically improved from 48 ± 19 at day 0 to 176 ± 70 × 109/L (P < 0.0001) and from 2469 ± 853 to 7198 ± 3982/L (P = 0.001) respectively. PS allowed significant reduction of splenic length and volume from 176 ± 33 to 112 ± 24 cm (P < 0.0001) and from 1228 ± 464 to 450 ± 297 cm3 (P = 0.0003) respectively. After a mean follow-up of 92.6 ± 84.7 months (range: 4.1-210.7), 14 patients are alive with normal platelet and WBC counts and persistent spleen size reduction. Compared to control group, PS was associated with a significant platelet count rise from baseline to one year.
Conclusions:
PS appears to be effective for treatment of hypersplenism and splenomegaly in combination with LT or VS without compromising outcome.
