Splenic vein diameter/portal vein diameter ratio as a predictor of portal vein thrombosis after laparoscopic splenectomy in children

Abstract Purpose This study aimed to identify predictors of portal vein thrombosis (PVT) after laparoscopic splenectomy (LS) in children. Methods Patients who underwent LS between September 2014 and August 2024 were retrospectively reviewed. Preoperative and intraoperative clinical data were compared between those with and without PVT. The splenic vein diameter (SVD) was measured at 2, 4, and 6 cm from the portal vein (PV) junction using preoperative transaxial computed tomography images. Results Among 21 patients who underwent LS, those with PVT were significantly older, more likely to be female, and had a higher body mass index. Although splenic maximum diameter, PV diameter, and the spleen volume/standard spleen volume ratio showed no significant differences, SVD was significantly larger at all measured locations in patients with PVT. Additionally, the SVD/portal vein diameter (PVD) ratio was significantly higher at all measured locations in these patients. Receiver operating characteristic analysis identified the SVD/PVD ratio as the most reliable predictor of PVT development, with an optimal cutoff value of 0.7. Conclusion An SVD/PVD ratio ≥ 0.7 is a strong predictor of PVT after LS in children. Measuring this ratio preoperatively may identify high-risk patients, allowing for closer monitoring and potential preventive interventions to reduce PVT incidence.