Objective: To assess the significance of the plasma D-dimer (D-D) level in predicting portal vein thrombosis (PVT) after laparoscopic splenectomy and esophagogastric devascularization (LSED) in patients with portal hypertension secondary to posthepatitic cirrhosis. Methods: Forty-seven patients with portal hypertension caused by posthepatitic cirrhosis scheduled for LSED were enrolled. The plasma D-dimer levels and coagulation function parameters of the patients before and at 1, 7 and 14 d after surgery were determined, color Doppler ultrasonography was performed on postoperative day (POD) 7 and 14 for PVT, and receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic efficiency of D-dimer level for post-LSED PVT. Results: Twenty-one of 47 patients developed PVT after LSED. The D-dimer levels in both PVT group and non-PVT group continued to rise after surgery, but the D-dimer levels in PVT group on POD 7 and 14 were significantly higher than those in non-PVT group (P<0.05). The prothrombin time PT, thrombin time (TT), and activated partial thrombin time (APTT) showed no obvious change before and after surgery in both PVT group and non-PVT group, and also showed no statistical difference between the two groups (P>0.05). The postoperative platelet (PLT) counts in both groups were increased compared with their preoperative levels, but showed no statistical difference between the two groups (P>0.05). The area under the ROC curve (AUC) reflecting the predictive accuracy of the D-dimer level on POD 7 for post-LSED PVT was 0.7 801 (P<0.05). Conclusion: Plasma D-dimer level is increased after LSED in patients with portal hypertension caused by posthepatitic cirrhosis, and the risk of PVT is increased in patients whose post-LSED plasma D-dimer sustains a high level (>14 mg/L), for whom, thrombus monitoring and preventive anticoagulation should be enhanced.