Laparoscopic splenectomy: posterolateral approach in patients with liver cirrhosis and portal hypertension with platelet count lower than 1 × 10⁹/l

Introduction
Laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis and portal hypertension in patients with an extremely low platelet count (< 1 × 10⁹/l) presents several challenges. The posterolateral laparoscopic splenectomy approach may be a feasible and safe technique for these patients.

Aim
To evaluate the feasibility and safety of the posterolateral laparoscopic splenectomy approach in patients with platelet counts < 1 × 10⁹/l secondary to liver cirrhosis and portal hypertension.

Material and methods
In the period from January 2013 to December 2016, 11 patients with platelet counts < 1 × 10⁹/l secondary to liver cirrhosis and portal hypertension underwent posterolateral laparoscopic splenectomy in our institution. Pre-, peri-, and postoperative medical managements were reviewed retrospectively.

Results
Patients’ median platelet count was 0.7 × 10⁹/l at the time of inpatient admission. The median operating time was 75 min, and the median intraoperative blood loss was 30 ml. One patient underwent intraoperative transfusion. The median duration of postoperative hospital stay was 5 days. No intra- or postoperative complications ensued, all patients were followed for 12–32 months (median: 24 months), and none had postoperative complications.

Conclusions
The posterolateral laparoscopic splenectomy approach is a feasible, safe technique in the treatment of patients with platelet counts < 1 × 10⁹/l secondary to liver cirrhosis and portal hypertension.