Are there any limits for laparoscopy in splenomegaly? Our experience

Santarelli, Mauro; Secco, Giacomo Lo; Celi, Daniele; Scozzari, Gitana; Pautasso, P.; Paolis, Paolo De

doi:10.1007/s13304-020-00876-6

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…2 Casaccia et al 14 demonstrated that LS is safe, feasible, and associated with better outcomes in the treatment of massive and giant spleens up to a maximum of 31 cm. However, Santarelli et al 15 demonstrated that a craniocaudal diameter > 22 cm was the most significant risk factor for conversion. This higher rate of complications in patients with MD may be attributed to both the underlying disease (nature, size, and weight of the spleen) and patient characteristics (age and BMI).…”

Section: Discussionmentioning

confidence: 99%

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Impact of Underlying Disease and Preoperative Factors on Postoperative Outcomes After Laparoscopic Splenectomy: A Bicentric Retrospective Analysis

Peltrini¹,

Nuzzo²,

Capua

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Although the laparoscopic approach is considered the gold standard for elective splenectomy, it is still debated whether the underlying disease affects postoperative outcomes. Given the importance of good patient selection in the early stages of the learning curve for laparoscopic splenectomy (LS), this study aimed to compare the postoperative outcomes following LS for malignant diseases and benign diseases (MDs and BDs). Materials and Methods: A retrospective review of patients who underwent LS was performed at 2 different institutions between January 2013 and September 2020. Patients were classified into 2 groups based on the underlying BDs or MDs, and the 30 days postoperative outcomes were compared. Risk factors for overall complications were determined using logistic regression analysis. Results: LS was performed for BDs and MDs in 51 (67%) and 25 (33%) patients, respectively. The overall morbidity rate and the intraoperative and postoperative complication rates were significantly higher in the MD group (P<0.05). In the univariate analysis, the underlying MD, age above 49.5 years, body mass index >24.9, the long axis of the spleen >16 cm, and spleen weight >600 g were significantly associated with increased postoperative morbidity. Conclusion: In addition to the underlying disease, preoperative conditions may also affect the complication rates after LS. These findings may be helpful in patient selection, especially in the early stages of the learning curve for minimally invasive splenectomies.

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Section: Discussionmentioning

confidence: 99%

“…Casaccia et al14 demonstrated that LS is safe, feasible, and associated with better outcomes in the treatment of massive and giant spleens up to a maximum of 31 cm. However, Santarelli et al15 demonstrated that a craniocaudal diameter >22 cm was the most significant risk factor for conversion.…”

Section: Discussionmentioning

confidence: 99%

Impact of Underlying Disease and Preoperative Factors on Postoperative Outcomes After Laparoscopic Splenectomy: A Bicentric Retrospective Analysis

Peltrini¹,

Nuzzo²,

Capua

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Usually, laparoscopic surgery with splenopexy should be preferred whenever feasible due to benefits over open splenopexy or splenectomy, such as preserving organic function and a quick recovery, mainly due to low postoperative pain and a prompt discharge from the hospital [ 12 , 13 ]. On the other hand, given the risk of torsion, most patients are now treated with splenectomy even when asymptomatic [ 11 , 14 – 16 ]. Indeed, to perform the splenectomy of a WS laparoscopically has already been reported as a save option [ 14 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Splenectomy of a Wandering Pelvic Splenomegaly in a Young Woman Treated in Childhood with Surgery for Diaphragmatic Hernia and Adhesiolysis for Intestinal Obstruction

et al. 2022

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Patient: Female, 32-year-old Final Diagnosis: Wandering spleen Symptoms: Abdominal and/or epigastric pain Medication:— Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Wandering spleen (WS) is a rare medical condition in which the spleen migrates from its usual position commonly to the pelvis or lower abdomen assuming an ever-wandering state. The incidence of ectopic spleen is 0.2%, with variable clinical manifestations from asymptomatic to abdominal emergency. Symptoms are most attributed to complications related to torsion, so that a nonoperative management of a WS is not advised. According to the literature, 69.5% of patients with WS need splenectomy and 78.6% need laparotomy. Case Report: The patient exhibited vague intermittent lower abdominal pain for 6 months due to progressive torsion of the spleen, which resulted in venous congestion. Abdominal investigation revealed a mobile intra-abdominal mass and parenchymatous consistency in the pelvis. Diagnosis by computed tomography outlined abdominal splenomegaly with abnormal position both of pancreas and stomach. Laparoscopy established a giant spleen, with a lengthened pelvic and twisty vascular pedicle. In its ectopic location, the spleen had dragged the pancreas with it, which had taken a vertical position. The classic splenic ligaments were not recognizable. Spleen was removed with median laparotomic incision. Splenectomy was performed to prevent any traumatic fractures of the spleen, a complete twist of the splenic hilum, and the onset of recurrent acute pancreatitis. Conclusions: Wandering spleen is rare in patients presenting with acute abdominal pain. An approach supported by clinical findings and investigation, even considering splenectomy over splenopexy, and laparoscopy over open surgery, may solve and prevent complications and health risks.

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Preoperative Splenic Artery Embolization for Massive Splenomegaly in Children: A Single Center Experience

Rollins

Rehman

Al-Hadidi

et al. 2022

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Are there any limits for laparoscopy in splenomegaly? Our experience

Cited by 3 publications

References 21 publications

Impact of Underlying Disease and Preoperative Factors on Postoperative Outcomes After Laparoscopic Splenectomy: A Bicentric Retrospective Analysis

Impact of Underlying Disease and Preoperative Factors on Postoperative Outcomes After Laparoscopic Splenectomy: A Bicentric Retrospective Analysis

Laparoscopic Splenectomy of a Wandering Pelvic Splenomegaly in a Young Woman Treated in Childhood with Surgery for Diaphragmatic Hernia and Adhesiolysis for Intestinal Obstruction

Preoperative Splenic Artery Embolization for Massive Splenomegaly in Children: A Single Center Experience

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