Our Summary

This research paper summarizes a detailed review and analysis of previous studies exploring the likelihood of developing splanchnic vein thrombosis (SVT) - a potentially deadly condition where a blood clot forms in the veins of the abdomen - in patients with liver cirrhosis who have undergone either a splenectomy (surgical removal of the spleen) or splenic artery embolization (a procedure to block the blood supply to the spleen).

The researchers examined 66 studies involving 5632 patients and found that around 25% of patients developed SVT after a splenectomy and around 12% after a splenic artery embolization. However, when they directly compared the two procedures, they found no significant difference in SVT incidence.

They also identified certain risk factors that made patients more likely to develop SVT after a splenectomy, including a high platelet count, large pre-operative spleen or portal vein diameter, fast pre- or post-operative blood flow in the portal vein, large spleen volume and weight, and a surgical procedure called periesophagogastric devascularization.

On the other hand, the use of blood-thinning medication after a splenectomy was found to lower the risk of SVT. The researchers suggest that such preventive measures might be particularly beneficial for high-risk patients.

FAQs

  1. What is the likelihood of developing splanchnic vein thrombosis (SVT) in patients who have undergone a splenectomy or splenic artery embolization?
  2. What are the identified risk factors that make patients more likely to develop SVT after a splenectomy?
  3. Does the use of blood-thinning medication after a splenectomy reduce the risk of SVT?

Doctor’s Tip

A helpful tip a doctor might tell a patient about splenectomy is to discuss the potential risk of developing splanchnic vein thrombosis (SVT) and to consider the use of blood-thinning medication as a preventive measure, especially for high-risk patients. It is also important to monitor for any signs or symptoms of SVT, such as abdominal pain, swelling, or changes in bowel habits, and to seek medical attention promptly if any concerning symptoms arise. Regular follow-up appointments with a healthcare provider are essential to monitor for any potential complications following a splenectomy.

Suitable For

Overall, patients with liver cirrhosis who have undergone a splenectomy or splenic artery embolization are at risk of developing SVT. Patients with certain risk factors, such as a high platelet count, large spleen size, and specific surgical procedures, are more likely to develop SVT after a splenectomy. However, the use of blood-thinning medication after the procedure can help lower this risk. Therefore, it is important for healthcare providers to carefully assess the individual risk factors of patients before recommending a splenectomy and to consider preventive measures to reduce the likelihood of developing SVT post-operatively.

Timeline

Before splenectomy:

  • Patient undergoes diagnostic tests to confirm the need for splenectomy, such as blood tests, imaging scans, and possibly a biopsy.
  • Patient may undergo pre-operative preparation, including discussing the risks and benefits of the procedure with their healthcare team and making any necessary arrangements for post-operative care.

During splenectomy:

  • Patient undergoes the surgical removal of the spleen under general anesthesia. The procedure can be done either through open surgery or laparoscopically.
  • After the spleen is removed, the patient is monitored closely in the recovery room for any complications.

After splenectomy:

  • Patient may experience pain, discomfort, and fatigue in the days following the surgery.
  • Patient is at an increased risk of infections, particularly from encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
  • Patient may be prescribed antibiotics and vaccinations to help prevent infections.
  • Patient may need to take precautions to prevent injuries that could result in bleeding, as the spleen plays a role in blood clotting.
  • Over time, the remaining organs in the body will compensate for the absence of the spleen.
  • Patient may need to undergo regular blood tests to monitor blood cell counts and liver function.

Overall, while splenectomy can provide relief from certain conditions, it also comes with potential risks and complications that patients need to be aware of and manage with the help of their healthcare team.

What to Ask Your Doctor

Some questions a patient should ask their doctor about splenectomy include:

  1. What are the potential risks and complications associated with a splenectomy?
  2. How likely am I to develop splanchnic vein thrombosis after a splenectomy?
  3. Are there any specific risk factors that I have that may increase my chances of developing splanchnic vein thrombosis?
  4. What preventive measures can be taken to lower my risk of developing splanchnic vein thrombosis after a splenectomy?
  5. How long will it take for me to recover from a splenectomy, and what can I expect during the recovery process?
  6. Will I need to take any medications or make any lifestyle changes after the surgery?
  7. Are there any alternative treatments to a splenectomy that may be less risky in terms of developing splanchnic vein thrombosis?
  8. How often will I need follow-up appointments after the surgery, and what will these appointments involve?
  9. Are there any specific signs or symptoms I should watch out for that may indicate the development of splanchnic vein thrombosis?
  10. What is the long-term outlook for someone who has undergone a splenectomy in terms of developing complications like splanchnic vein thrombosis?

Reference

Authors: Wu Y, Li H, Zhang T, Bai Z, Xu X, Levi Sandri GB, Wang L, Qi X. Journal: Adv Ther. 2021 Apr;38(4):1904-1930. doi: 10.1007/s12325-021-01652-7. Epub 2021 Mar 9. PMID: 33687650