Balakumaran Sathyamoorthy, Sugaprakash Sankareshwaran, Rajendran Vellaisamy, Perungo Thirumaraiselvan, Jeyasudhakar Jesudasan, John Grifson John Rose, Heber Anandan, Kannan Devy Gounder
Introduction Even though splenectomy is considered as treatment of choice for those with bleeding varices, no consensus has been arrived at regarding management of asymptomatic splenic vein thrombosis while undergoing surgical management for pain in chronic pancreatitis. Objective Whether adding splenectomy while performing surgical procedure for chronic pancreatitis influences the outcome of patients with asymptomatic splenic vein thrombosis is assessed in this retrospective study. Methods splenic vein thrombosis was found in 39 cases among a total of 365 patients (10.7%) operated for chronic pancreatitis between 2009 and 2015. 21 patients underwent splenectomy and 11 underwent only pancreatic procedures and 7 patients are treated with non-surgical management. Bleeding manifestations prior to the surgery were found only in 17 patients. On follow up reduction in size of varices and restoration of flow in splenic vein, rate of rebleeding and morbidity and mortality were analyzed. Median follow-up period was 36 months (Range 10-88 months). Results None of them in the splenctomised patients bleed in the follow up. 4 patients in the non spleenctomised patients developed bleeding in the follow up. 3 patients expired after admission with bleeding manifestations. Another patient developed features of hyperspleenism and required splenectomy in the follow up. None of the factors significantly predicted the risk of bleeding. Conclusion The rate of bleeding is high in surgical population of chronic pancreatitis hence we strongly advise splenectomy as a single stage treatment while performing surgical management of chronic pancreatitis especially in patients with remote access to health care facilities.
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