EFFECT OF SPLENECTOMY ON LIVER FIBROGENICITY IN PORTAL HYPERTENSION PATIENTS

El Batanouny, M; M. Essawy, Mohamed; Ezzat, Hussein; Abbas, Mohamed; M. Nosseir, Mona; S. Omran, Zainab; A. Khaled, Iman

doi:10.21608/ejsur.2001.375850

EFFECT OF SPLENECTOMY ON LIVER FIBROGENICITY IN PORTAL HYPERTENSION PATIENTS

Document Type : Original Article

Authors

¹ General Surgery Department of Kasr El-Aini, Cairo University, Egypt.

² General Surgery, Theodor Bilharz Research Institute

³ Pathology, Theodor Bilharz Research Institute

⁴ Hematology Departments, Theodor Bilharz Research Institute

10.21608/ejsur.2001.375850

Abstract

This study was designed to assess the role of the spleen on the presence and localization of liver fibronectin, to measure
the amount of hepatic collagen and serum level of fibronectin and procollagen III in cases of portal hypertension.
The study was performed on 40 patients divided into two groups: Portal hypertension group (20 patients) included one
pure schistosomal hepatic fibrosis, three mixed schistsomal and virus C cirrhosis, ten virus C hepatic cirrhosis, two virus B
hepatic cirrhosis and four mixed B&C infections. Control group (20 patients) presented with different splenic insults without hepatic affection. In the first group, through clinical examinations and sonographic findings revealed hepatosplenomegaly and grade III & IV varices with history of injection sclerotherapy in 65% of cases.
Preoperatively, marked hepatic fibronectin deposition in portal tracts and around blood vessels raised the stage of
fibrosis. This was accompanied by decrease in plasma level of fibronectin and increase of serum level of procollagen III in
relation to the control group.
Six months post-operatively, tissue fibronectin, collagen content and serum procollagen III were insignificantly
decreased. However, plasma level of fibronectin was increased significantly.
These results denoted that fibronectin is one of the predominant early fibrogenic components in chronic liver diseases,
stimulating further collagen deposition. It is concluded that the role of the spleen in the development of hepatic fibrosis seems ancillary. Multifactorial influences, including etiology, timing of splenectomy, hepatic vascular adjustment, and factors associated with the biology of extracellular matrix of the liver, probably play a more significant role. Further studies were recommended to assess the role of splenectomy on liver fibrogensis at different stages of fibrosis. Intervention with splenectomy could improve or reverse fibrogenic activity at early stages.

Keywords