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. 2022 Dec;36(12):8918-8926.
doi: 10.1007/s00464-022-09340-5. Epub 2022 Jun 28.

Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization

Yongning Li #  1   2 , Xueqin Fu #  3 , Ying Li #  2 , Peng Liu  1   2 , Songbai Liu  2 , Yaozhen Pan  4
Affiliations

Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization

Yongning Li et al. Surg Endosc. 2022 Dec.

Abstract

Background: Portal vein system thrombosis (PVST) is a common postoperative complication brought by laparoscopic splenectomy and pericardial disconnection (LSD) among patients who suffered from portal hypertension and hypersplenism. This research lies mainly in probing into the risk factors of PVST and evaluating the effects of warfarin on PVST prevention.

Materials and methods: We took 131 individuals who have carried out LSD from January 2015 to January 2021. Patients were divided into warfarin group (n = 68) and aspirin group (n = 63). Meanwhile, thrombosis factors were analyzed in PVST arm (n = 48) and non-PVST arm (n = 83).

Results: We analyzed the early postoperative anticoagulation effect, 20 patients (29.4%) in the warfarin group developed PVST, and 28 patients (44.4%) in the aspirin group. The chance to PVST during the first year after operation was lower in the warfarin group than in the aspirin group (F = 13.43, P = 0.006). Risk factors for PVST were analyzed, and diabetes, the diameter of the portal vein and splenic vein, and the velocity of portal blood flow were statistically significant between the PVST arm and non-PVST arm (P < < 0.05). Multiple logistic regression analyses have shown that diabetes, portal vein diameter, splenic vein diameter, and the velocity of portal blood flow were the risk factors of PVST.

Conclusions: The portal vein diameter, splenic vein diameter, portal vein flow velocity, and diabetes are risk factors for the PVST after LSD. The prophylactic use of warfarin anticoagulation markedly decreases the probability of occurrence of the PVST in patients with portal hypertension after LSD compared to aspirin.

Keywords: Liver cirrhosis; Portal hypertension; Portal vein thrombosis; Splenectomy; Warfarin.

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Conflict of interest statement

Drs Yongning Li, Xueqin Fu, Ying Li, Peng Liu, Songbai Liu, and Yaozhen Pan have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
The postoperative chance of PVST in patients with portal hypertension and hypersplenism undergoing LSD
Fig. 2
Fig. 2
The postoperative chance of MPVT in patients with portal hypertension and hypersplenism undergoing LSD
Fig. 3
Fig. 3
The postoperative chance of SVT in patients with portal hypertension and hypersplenism undergoing LSD
See this image and copyright information in PMC

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