Postsplenectomy portal, mesenteric, and splenic vein thrombosis

We read with great interest the article "Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins," by Stamou et al.1 There has been increasing concern that laparoscopic surgery may increase the risk of mesenteric and portal venous thrombosis.2-3 In the prospective controlled trial by Ikeda et al2 of laparoscopic vs open splenectomy followed by postoperative computed tomographic scans, they demonstrated a 55% (laparoscopic) vs 19% (open) incidence of postoperative portal venous thrombosis. Romano et al,3 in their prospective uncontrolled trial, demonstrated a 19% incidence of postoperative portal venous thrombosis detected by ultrasound. Laparoscopic surgery may increase venous thrombosis through a number of mechanisms. First, insufflation of the abdomen with the rise in intra-abdominal pressure may increase the risk of venous stasis. Second, the technique of ligation of the splenic vessels with a stapler . .