Minimally invasive splenectomy for thrombocytopenia associated with liver cirrhosis

Thrombocytopenia is a common complication in patients with chronic liver disease and corelates with the severity of cirrhosis. Severe trombocytopenia can sinificantly increase the risk of spontaneous bleeding, but even if it is not symptomatic it can complicate the medical management of the cirrhotic patient by postponing diagnistic or therapeutic procedures (liver biopsy, interferon therapy, hepatocellular carcinoma resection). In consequence, numerous procedures were imagined to reverse thrombocytopenia associated with liver cirrhosis, among wich splenectomy. Due to the extreme invasiveness of the clasic approach in patients with hipersplenism (risk of bleeding, postoperative pain) especially in those with advanced cirrhosis, minimally invasive splenectomy appears to offer a safe and effective method for reversing thrombocytopenia in a highly selected group of patients with liver cirrhosis (Child A cirrhosis without other significant medical comorbid conditions). In these cases the surgical procedure is associated with low morbidity, blood loss and short hospital stay.