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Laparoscopic splenectomy with peginterferon and ribavirin therapy for patients with hepatitis C virus cirrhosis and hypersplenism

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This study aimed to evaluate whether laparoscopic splenectomy (Lap-Sp) contributes to the completion and curability of combined peginterferon and ribavirin (peg-IFN + RIB) therapy for cirrhotic patients with pancytopenia due to hypersplenism.


From December 2004 to September 2007, 21 patients underwent Lap-Sp before treatment with peg-IFN + RIB. All the patients were Child-Pugh class A or B with a mean platelet count of 5.7 × 104/mm3 and a mean leukocyte count of 2,830/mm3. The hepatitis C virus (HCV) genotype was 1b for 18 patients and 2b for 3 patients. Of the 21 patients, 17 had a viral load exceeding 100 KIU/ml, and 4 had a load of less than 100 KIU/ml.


All the patients underwent Lap-Sp without severe complications. The average hospital stay was 12.7 days (range, 6–23 days). Platelet counts increased from a mean of 5.7 ± 2.2 × 104/mm3 preoperatively to 19.6 ± 7.6 × 104/mm3 postoperatively and remained above 7.0 × 104/mm3 during the subsequent peg-IFN + RIB therapy. The full course of therapy was completed for nine patients, with five obtaining a sustained virologic response and one obtaining a biologic response. The five patients who obtained a sustained virologic response had either HCV type 2b or 1b with a low viral load (<100 KIU). At this writing, treatment is ongoing for the remaining 12 patients.


Laparoscopic splenectomy allows patients with HCV cirrhosis and hypersplenism to receive full-dose peg-IFN + RIB therapy. Patients with HCV, genotype 2 or 1b and a low viral load, and hypersplenism may be good candidates for Lap-Sp.

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  1. 1.

    Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL Jr, Haussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J (2002) Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 347:975–982

  2. 2.

    Yoshida H, Shiratori Y, Moriyama M, Arakawa Y, Ide T, Sata M, Inoue O, Yano M, Tanaka M, Fujiyama S, Nishiguchi S, Kuroki T, Imazeki F, Yokosuka O, Kinoyama S, Yamada G, Omata M (1999) Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. Ann Intern Med 131:174–181

  3. 3.

    Bruno S, Stroffolini T, Colombo M, Bollani S, Benvegnù L, Mazzella G, Ascione A, Santantonio T, Piccinino F, Andreone P, Mangia A, Gaeta GB, Persico M, Fagiuoli S, Almasio PL, Italian Association of the Study of the Liver Disease (AISF) (2007) Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology 45:579–587

  4. 4.

    Ikeda K, Saitoh S, Arase Y, Chayama K, Suzuki Y, Kobayashi M, Tsubota A, Nakamura I, Murashima N, Kumada H, Kawanishi M (1999) Effect of interferon therapy on hepatocellular carcinogenesis in patients with chronic hepatitis type C: a long-term observation study of 1, 643 patients using statistical bias correction with proportional hazard analysis. Hepatology 29:1124–1130

  5. 5.

    Russo MW, Fried MW (2003) Side effects of therapy for chronic hepatitis C (review). Gastroenterology 123:1711–1719

  6. 6.

    Renault PF, Hoofnagle JH (1989) Side effects of alpha interferon. Semin Liver Dis 9:273–277

  7. 7.

    Hoofnagle JH (1991) Thrombocytopenia during interferon alfa therapy. JAMA 266:849

  8. 8.

    Peck-Radosavljevic M, Wichlas M, Pidlich J, Sims P, Meng G, Zacherl J, Garg S, Datz C, Gangl A, Ferenci P (1998) Blunted thrombopoietin response to interferon alfa-induced thrombocytopenia during treatment for hepatitis C. Hepatology 28:1424–1429

  9. 9.

    Soza A, Everhart JE, Ghany MG, Doo E, Heller T, Promrat K, Park Y, Liang TJ, Hoofnagle JH (2002) Neutropenia during combination therapy of interferon alfa and ribavirin for chronic hepatitis C. Hepatology 36:1273–1279

  10. 10.

    Hashizume M, Sugimachi K, Kitano S, Shimada M, Baba H, Ueno K, Ohta M, Tomikawa M (1994) Laparoscopic splenectomy. Am J Surg 167:611–614

  11. 11.

    Hashizume M, Tomikawa M, Akahoshi T, Tanoue K, Gotoh N, Konishi K, Okita K, Tsutsumi N, Shimabukuro R, Yamaguchi S, Sugimachi K (2002) Laparoscopic splenectomy for portal hypertension. Hepatogastroenterology 49:847–852

  12. 12.

    Kercher KW, Carbonell AM, Heniford BT, Matthews BD, Cunningham DM, Reindollar RW (2004) Laparoscopic splenectomy reverses thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension. J Gastrointest Surg 8:120–126

  13. 13.

    Ichida F, Tsuji T, Omata M (1996) New Inuyama classification: new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 6:112–119

  14. 14.

    Winslow ER, Brunt LM, Drebin JA, Soper NJ, Klingensmith ME (2002) Portal vein thrombosis after splenectomy. Am J Surg 184:631–635

  15. 15.

    Hassn AM, Al-Fallouji MA, Ouf TI, Saad R (2000) Portal vein thrombosis following splenectomy. Br J Surg 87:362–373

  16. 16.

    Chaffanjon PC, Brichon PY, Ranchoup Y, Gressin R, Sotto JJ (1998) Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging. World J Surg 22:1082–1086

  17. 17.

    Sangro B, Bilbao I, Herrero I, Corella C, Longo J, Beloqui O, Ruiz J, Zozaya JM, Quiroga J, Prieto J (1993) Partial splenic embolization for the treatment of hypersplenism in cirrhosis. Hepatology 18:309–314

  18. 18.

    Alwmark A, Bengmark S, Gullstrand P, Joelsson B, Lundequist A, Owman T (1982) Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg 196:518–524

  19. 19.

    Hong YC, Wu HK, Yang AD (1999) Evaluation of partial splenic embolization in patients with hypersplenism in cirrhosis. Chin J Radiol 24:233–237

  20. 20.

    Noguchi H, Hirai K, Aoki Y, Sakata K, Tanikawa K (1995) Changes in platelet kinetics after a partial splenic arterial embolization in cirrhotic patients with hypersplenism. Hepatology 22:1682–1688

  21. 21.

    Vujic I, Lauver JW (1981) Severe complications from partial splenic embolization in patients with liver failure. Br J Radiol 54:492–495

  22. 22.

    Kato M, Shimohashi N, Ouchi J, Yoshida K, Tanabe Y, Takenaka K, Nakamuta M (2005) Partial splenic embolization facilitates completion of interferon therapy in patients with chronic HCV infection and hypersplenism. J Gastroenterol 40:1076–1077

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Correspondence to Tomohiko Akahoshi.

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Akahoshi, T., Tomikawa, M., Korenaga, D. et al. Laparoscopic splenectomy with peginterferon and ribavirin therapy for patients with hepatitis C virus cirrhosis and hypersplenism. Surg Endosc 24, 680–685 (2010). https://doi.org/10.1007/s00464-009-0653-6

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  • Chronic HCV infection
  • Hypersplenism
  • Laparoscopic splenectomy
  • Pegylated interferon
  • Ribavirin