A laparoscopic splenectomy allows the induction of antiviral therapy for patients with cirrhosis associated with hepatitis C virus

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Source: Am Surg

A laparoscopic splenectomy allows the induction of antiviral therapy for

patients with cirrhosis associated with hepatitis C virus;

Shigekawa Y, Uchiyama K, Takifuji K, Ueno M, Hama T, Hayami S, Tamai H, Ichinose

M, Yamaue H;

American Surgeon 77 (2), 174-9 (Feb 2011)

It is difficult to treat patients with cirrhosis-associated hepatitis C with

pegylated interferon (PEG-IFN) and ribavirin because of thrombocytopenia-related

hypersplenism. Both safety and clinical efficacy were retrospectively analyzed

for patients who underwent a laparoscopic splenectomy (LS) from January 2003 to

December 2007. A total of 35 patients with cirrhosis associated with hepatitis C

virus had LS for thrombocytopenia before PEG-IFN and ribavirin therapy, and all

patients had thrombocytopenia, which was a contraindication for antiviral

therapy. The hepatopathy was Child A in 24 patients, Child B in 10 patients, and

Child C in one patient. All 35 patients increased platelet count from 48,000 +/-

15,000 to 155,000 +/- 55,000/microl (P<0.0001) after LS. The median hospital

stay and blood loss were 13.0 days (range, 8 to 57 days) and 342.0 mL (range, 5

to 2350 mL). There was no postoperative death. Twenty-nine (83%) patients had

PEG-IFN and ribavirin therapy after LS; 18 had complete therapy and 11 had

partial therapy. Of these, nine had a sustained virologic response. A

laparoscopic splenectomy for patients with cirrhosis associated with hepatitis C

virus can be performed safely and allows induction of antiviral treatment.