Is splenectomy necessary in devascularization procedures for treatment of bleeding portal hypertension?

Objective: To investigate whether splenectomy as a part of devascularization procedures is necessary. Design: Prospective, controlled, randomized trial. Setting: University hospital, referral center. Patients: A total of 55 patients (Child-Pugh class A and B) with a history of bleeding portal hypertension were treated by means of a modified Sugiura-Futagawa procedure. Twenty-three patients underwent splenectomy and 22 did not. Methods: Postoperative outcome was recorded and comparison of the 2 groups was done with the Fisher exact test. Kaplan-Meier survival curves were constructed. Main outcome and postoperative differences between the patients who underwent splenectomy and those who did not were investigated. Results: Both groups were comparable in the postoperative period. Significant differences were observed in transfusion requirements and postoperative portal vein thrombosis, both favoring the group without splenectomy. No differences in rebleeding, encephalopathy rate, operative time, or postoperative complications were observed. Conclusion: Splenectomy is not routinely necessary in devascularization procedures for bleeding portal hypertension.