SPLENEKTOMİ YAPILAN HASTALARDA POSTOPERATİF KOMPLİKASYON GELİŞİMİNİN PORTAL VEN TROMBOZUNA ETKİSİ

Yıl 2023, Cilt: 86 Sayı: 4, 354 - 359, 01.12.2023

Veysel Umman , Hafize Basut Atalay , Recep Temel , Turan Alisoy , Kaan Balcı , Sedat Fırat Okutan , Taylan Özgür Sezer , Özgür Fırat , Sinan Ersin

https://doi.org/10.26650/IUITFD.1352652

Öz

Amaç: Terapötik ve acil splenektomi sonrası gelişen önemli komplikasyonlardan biri venöz tromboembolidir. Hematolojik malignite nedeniyle splenektomi sonrası ilk iki ay içerisinde %35’e varan portal ve splenik venöz tromboembolizm bildirilmiştir. Bu çalışmada, acil ve elektif splenektomi operasyonlarını ve komplikasyonlarını karşılaştırarak portal ven trombozu (PVT) gelişimi üzerindeki risklerin incelenmesi amaçlandı.
Gereç ve Yöntem: Çalışmaya 2017-2023 yılları arasında gerçekleştirilen ve kayıtları eksiksiz olan 78 splenektomi vakası dahil edildi. Bu vakalardan 39'u acil, 39'u ise elektif prosedürlerdi. İki grup portal tromboembolizm ve riskleri açısından retrospektif olarak karşılaştırıldı.
Bulgular: Ameliyat sonrası komplikasyon görülmesi ile PVT gelişimi riski arasında anlamlı bir ilişki saptanmıştır (p=0,004). Operasyon tipi olarak inclediğimizdeyse ameliyat sonrası ilk iki haftalık süreçteki acil vakalarda PVT gelişimi riski, elektif vakalara göre anlamlı ölçüde yüksek bulunmuştur (p=0,048). Ayrıca, kısa ameliyat süresi, büyük dalak boyutu, düşük trombosit sayısı ve patoloji sonuçlarında malignite olması elektif vakalar lehine anlamlı bulunmuştur (sırasıyla p=0,007, p=0,004, p<0,001, p=0,001, p=0,001). Acil vakalardaysa kan replasmanı ihtiyacı ve komplikasyonlar daha sık görülmüştür (sırasıyla p<0,001, p=0,021).
Sonuç: Yüksek riskli hastalar ameliyat sonrasındaki dönemde ve taburculuk sonrasında düşük molekül ağırlıklı heparin ile profilaktik antikoagülasyon açısından değerlendirilmelidir. Acil splenektomi vakalarında kar/zarar oranı göz önünde bulundurularak antikoagülasyon düşünülmeli ve olası venöz tromboemboli için şüphe eşiği düşük tutulup erken tetkik edilmelidir. Bu anlamda çalışmamız güncel sonuçları ile mevcut verileri desteklemektedir.

Anahtar Kelimeler

Splenektomi, portal tromboz, acil cerrahi, splenomegali

IMPACT OF POSTOPERATIVE COMPLICATIONS ON PORTAL THROMBOSIS IN SPLENECTOMY PATIENTS

Öz

Objective: Venous thromboembolism is one of the significant complications after elective and emergency splenectomy. Up to 35% of portal and splenic venous thromboembolism has been reported in the first two months after splenectomy for hematologic malignancy. Our objectives were to compare emergency and elective splenectomy and their complications, and to analyze the risks on the development of portal vein thrombosis (PVT).
Material and Method: A total of 78 splenectomy cases performed between 2017-2023 and that had complete medical records were included in this study. Of these cases, 39 were emergency and 39 were elective procedures. The two groups were compared retrospectively for risks of PVT.
Result: We found a significant relationship between the development of postoperative complications and the risk of PVT (p=0.004). The risk of developing PVT in emergency cases in the post-operative 2 weeks was significantly higher than elective cases (p=0.048). Shorter operation times, larger spleen sizes, lower platelet counts and malignancy in pathology results were found to be significantly in favor of elective cases (p=0.007, p=0.004, p<0.001, p=0.001, respectively). In emergency cases, the need for RBC transfusion and complications were more frequent (p<0.001, p=0.021).
Conclusion: High-risk patients should be evaluated for prophylacticanticoagulation with low-molecular-weight heparin in the postoperative period and after discharge. Anticoagulation should be considered for emergency splenectomy, factoring in cost-benefit, and a low suspicion for venous thromboembolism should be maintained with timely investigation. In this sense, our study supports the existing data with its current results.

Anahtar Kelimeler

Splenectomy, portal thrombosis, emergency surgery, splenomegaly

Kaynakça

• Attina’ G, Triarico S, Romano A, Maurizi P, Mastrangelo S, Ruggiero A. Role of partial splenectomy in hematologic childhood disorders. Pathogens. 2021;10(11):1436. google scholar
• Goodwin EF, Partain PI, Lebensburger JD, Fineberg NS, Howard TH. Elective cholecystectomy reduces morbidity of cholelithiasis in pediatric sickle cell disease. Pediatric Blood Cancer. 2017;64(1):113-20. google scholar
• Crary SE, Buchanan GR. Vascular complications after splenectomy for hematologic disorders. Blood 2009;114(14):2861-8. google scholar
• van’t Riet M, Burger JW, van Muiswinkel JM, Kazemier G, Schipperus MR, Bonjer HJ. Diagnosis and treatment of portal vein thrombosis following splenectomy. Br J Surg 2000;87(9):1229-33. google scholar
• Szasz P, Ardestani A, Shoji BT, Brooks DC, Tavakkoli A. Predicting venous thrombosis in patients undergoing elective splenectomy. Surg Endosc 2020;34(5):2191- 6. google scholar
• Dendle C, Spelman T, Sundararajan V, Chunilal S, Woolley I. An analysis of the thromboembolic outcomes of 2472 splenectomized individuals. Blood 2015;125(10):1681-2. google scholar
• Fujita F, Lyass S, Otsuka K, Giordano L, Rosenbaum DL, Khalili TM, et al. Portal vein thrombosis following splenectomy: identification of risk factors. Am Surg 2003;69(11):951-6. google scholar
• Hassn AM, Al-Fallouji MA, Ouf TI, Saad R. Portal vein thrombosis following splenectomy. Br J Surg 2000;87(3):362- 73. google scholar
• Chaffanjon PC, Brichon PY, Ranchoup Y, Gressin R, Sotto JJ. Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging. World J Surg 1998;22(10):1082-6. google scholar
• Harris W, Marcaccio M. Incidence of portal vein thrombosis after laparoscopic splenectomy. Can J Surg 2005;48(5):352- 4 google scholar
• Winslow ER, Brunt LM, Drebin JA, Soper NJ, Klingensmith ME. Portal vein thrombosis after splenectomy. Am J Surg 2002;184(6):631-6. google scholar
• Tsamalaidze L, Stauffer JA, Brigham T, Asbun HJ. 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 2018;216(6):1192-204. google scholar
• Ikeda M, Sekimoto M, Takiguchi S, Kubota M, Ikenaga M, Yamamoto H, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg 2005;241(2):208-16. google scholar
• Segalini E, Khan M, Podda M, Gallo G, Morello A, Marziali I, et al. The role of laparoscopic splenectomy in traumatic splenic injury: a narrative review. Minerva Surg 2023;78(1):76-80. google scholar
• Di Buono G, Maienza E, Buscemi S, Gulotta L, Romano G, Agrusa A. Laparoscopic near-total splenectomy. Report of a case. Int J Surg Case Rep 2020;77S(Suppl):S44-7. google scholar
• Huang D, Tao M, Cao L, Wang X, Zheng S, Cao Y. Risk factors and anticoagulation effects of portal vein system thrombosis after laparoscopic splenectomy in patients with or without cirrhosis. Surg Laparosc Endosc Percutan Tech 2019;29(6):498-502. google scholar
• James AW, Rabl C, Westphalen AC, Fogarty PF, Posselt AM, Campos GM. Portomesenteric venous thrombosis after laparoscopic surgery: a systematic literature review. Arch Surg 2009;144(6):520-6. google scholar