Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism

Figure 1 Preoperative computed tomography scan of patients with advanced cirrhosis combined with severe splenomegaly.

Figure 2 Surgical procedure of partial splenectomy during liver transplantation. A: Partial splenectomy for severe hypersplenism was performed after classic orthotopic liver transplantation; B: The main splenic artery was isolated and exposed; C: The hilar vessels from the lower pole of the spleen were selectively ligated; D: The main collateral circulation of the spleen was isolated and ligated; E: Ischemic demarcation line became observable; F: The spleen was resected along the ischemic line using a Cavitron ultrasonic surgical aspirator and bipolar coagulation forceps; G: The segmental hilar vessels were allowed to remain with the splenic remnant; H: The spleen specimen.

Figure 3 Removal of half or one third of the spleen according to the splenic hilum vessel anatomy. The red line represents half splenectomy, and the green line represents one-third splenectomy.

Figure 4 Postoperative changes in the two groups. A: Spleen volume; B: Hepatic artery flow; C: Portal vein flow; D: Alanine transaminase; E: Platelet count; F: Leukocyte count. HA: Hepatic artery; PV: Portal vein; ALT: Alanine transaminase; PreOP: Preoperative.

Figure 5 Chronologic changes in the splenic volume after liver transplantation or partial splenectomy during liver transplantation. PreOP: Preoperative; LT: Liver transplantation; PSLT: Partial splenectomy during liver transplantation.