Effect of Laparoscopic Splenectomy on Lipid Profiles in Cirrhotic Patients With Hypersplenism (2-Year Follow-Up)

Rationale: Liver cirrhosis disrupts hepatic lipid homeostasis through multiple mechanisms, including decreased apolipoprotein synthesis, impaired cholesterol esterification, and altered very-low-density lipoprotein (VLDL) secretion, resulting in characteristic lipid abnormalities such as hypocholesterolemia and low high-density lipoprotein cholesterol (HDL-C). Hypersplenism further complicates this metabolic profile through increased lipid peroxidation and inflammatory cytokine-mediated dysregulation of lipid metabolism. Laparoscopic splenectomy (LS) reduces splenic sequestration and inflammatory burden, potentially improving hepatic lipid synthetic capacity and peripheral lipid clearance. However, perioperative stress responses, anesthetic effects, and abrupt hemodynamic changes may transiently worsen lipid profiles. Current evidence lacks prospective, 2-year data on lipid profile dynamics after LS in this population, particularly regarding the trajectory of total cholesterol, triglycerides, LDL-C, HDL-C. This study aims to fill this gap to guide perioperative metabolic monitoring and long-term dyslipidemia management.

Study Design: Prospective, single-center, observational cohort study with a total duration of 24 months (2 years). Patients with cirrhosis, splenomegaly and hypersplenism scheduled for elective laparoscopic splenectomy will be enrolled and followed for 2 years to assess lipid profile dynamics and identify risk factors for metabolic deterioration or improvement.

Study Timeline:

Months 1-6: Patient screening, enrollment, baseline lipid assessment Months 1-18: Laparoscopic splenectomy and perioperative short-term lipid monitoring Months 7-24: Long-term follow-up at 3, 6, 9,12, 24 months postoperatively Month 24: Data analysis and study completion

Inclusion criteria

• Age 18-80 years, male or female
• Confirmed diagnosis of liver cirrhosis (clinical, laboratory, imaging)
• Splenomegaly and hypersplenism
• Child-Pugh Class A or B liver function
• Signed written informed consent
• Ability to complete 24-month follow-up

Exclusion criteria

• Child-Pugh Class C liver cirrhosis
• No history of portal hypertension bleeding (esophageal and gastric variceal bleeding )
• Previous abdominal surgery precluding safe laparoscopic splenectomy.
• Severe cardiac, pulmonary, cerebrovascular dysfunction; malignant tumors; primary hematological disorders
• Metabolic/endocrine diseases: Familial hyperlipidemia; uncontrolled severe diabetes mellitus, thyroid dysfunction, nephrotic syndrome; use of lipid-lowering drugs, hormones, or other drugs affecting blood lipids within 1 month before surgery.
• Infections/inflammatory diseases: Active hepatitis, severe infections, or autoimmune diseases.
• Cirrhotic complications (hepatic encephalopathy, refractory ascites) within 1 month before surgery
• Pregnancy or lactation
• Poor compliance, inability to complete follow-up