PVT after splenectomy
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* Abdul-Wahed Meshikhes

I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparoscopic splenectomy (*Can J Surg* 2005;48:352–4).1 I agree with the authors’ assumption that the frequency of PVT after laparoscopic splenectomy is just as high as that after open splenectomy. I believe that the laparoscopic procedure per se has no bearing on the occurrence of PVT, which is found mainly in patients who undergo splenectomy for benign and malignant hematologic conditions. I also believe that PVT is more likely to occur after splenectomy if the postsplenectomy platelet count is greater than 1000 × 109/L, although it may occur at lower counts as the authors have indicated.

In a review of 55 patients who underwent open splenectomy for various indications in our unit, only 2 (3.6%) had PVT; both had portal hypertension, and splenectomy was performed as part of an emergency devascularization procedure for bleeding esophageal varices.2 PVT should be suspected in any patient who is not progressing smoothly in the early postoperative period after splenectomy and who complains of vague upper abdominal pain and has a low-grade fever in the absence of an apparent cause. The 2 patients who suffered PVT in the authors’ study had idiopathic thrombocytopenia (ITP). In our series, none of the patients with ITP had PVT, and although we practise in an area where sickle cell disease is prevalent, none of them suffered PVT after splenectomy.2 Also, although hematologic causes were the second commonest indication for splenectomy after trauma, PVT did not develop, casting doubt on the assumption that PVT is more common after splenectomy for hematologic conditions. My personal theory — which needs further substantiation — is that the frequency of splenic and portal vein thrombosis is increased when the splenic artery is first tied before proceeding with splenectomy. For the time being, we have to accept — as the authors implied — that there is no increased incidence of PVT after laparoscopic splenectomy.

## Footnotes

*   **Competing interests:** None declared.

## References

1.  Harris W, Marcaccio M. Incidence of portal vein thrombosis after laparoscopic splenectomy. Can J Surg 2005;48:352–4.
    
    

2.  Meshikhes AW, Mubarek MA, Abu-Alrahi AI, et al. The pattern of indications and complications of splenectomy in Eastern Saudi Arabia. Saudi Med J 2004;25:447–50.
    
    [Abstract/FREE Full Text](http://canjsurg.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic21qIjtzOjU6InJlc2lkIjtzOjg6IjI1LzQvNDQ3IjtzOjQ6ImF0b20iO3M6MjA6Ii9janMvNDkvMi8xMzguMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)