Open AccessSinistral Portal Hypertension Splenectomy or Expectant Management
Author(s) -
J P Loftus,
David M. Nagorney,
D Ilstrup,
Allen R. Kunselman
Publication year - 1993
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-199301000-00007
Subject(s) - splenectomy , medicine , portal hypertension , asymptomatic , surgery , varices , cirrhosis , spleen
Splenectomy has been considered the treatment of choice for patients with bleeding from sinistral portal hypertension (SPH) and varices, but is controversial for asymptomatic patients. To further define the role of splenectomy for SPH, the authors compared the clinical presentations and outcomes of 25 patients treated with splenectomy with those of 12 observed patients. Clinical features were similar except for transfusions administered (60% vs. 25%, p < 0.05), hemoglobin (9.8 +/- 2.2 g/dL vs. 12.5 +/- 2.1 g/dL, p < 0.05), and history of prior bleeding episodes (56% vs. 8%, p < 0.05), splenectomy versus no splenectomy, respectively. At 3 years, neither survival (78% vs. 64%, p = 1.0) nor new or recurrent bleeding (16% vs. 24%, p = 0.2) differed, splenectomy versus no splenectomy, respectively. The authors conclude that in the absence of prior bleeding episodes, anemia, or severe hemorrhage, observation of patients with SPH is justified.