Laparoscopic splenectomy: a personal series of 140 consecutive cases

Abstract

Ann R Coll Surg Engl 2010; 92: 398-402 398Since the first laparoscopic splenectomy in 1991, 1 the procedure has been rapidly established as a safe and effective treatment for a range of benign and malignant haematological conditions. The procedure has tended to take longer than open splenectomy with median operating times in recently reported series of 85-231 min; 2-6 however, it is associated with low morbidity rates of 18-26% 2,5,7 and zero mortality in some series 5,7-10 with others recently reporting mortality of up to 4%. 2,4,11,12 The hospital stay is also shorter 7,13 with mean hospital stay reported of 2.4-5 days 5,6,8,10,12,14,15 and even one small series reported successful day-case laparoscopic splenectomy. 15 There is not an increased risk of missing accessory spleens, 16 and the conversion rate to open operation is reported at 0-15% in recent series. [2][3][4][5][6]9,10,14,15,18,19 Little data are present in the literature examining the role of laparoscopic splenectomy in the case of splenomegaly, and there has been concern regarding higher conversion rates and morbidity. 20 Several reports suggest advantages of hand-assisted techniques with laparoscopic splenectomy for massive spleens. 4,15,21 However, recently, a small series did not require hand assistance or conversion to open operation in the latter part of their experience. 12Other centres have advocated open splenectomy for spleens larger than 1 kg. 22The aim of this study was to evaluate the results of a large, single-centre experience of laparoscopic splenectomy, focusing on morbidity, hospital stay, and conversion to open operation. In particular, the role of laparoscopic splenectomy in cases of splenomegaly over 1 kg was examined. RESULTS In total 140 laparoscopic splenectomies were performed with a complication rate of 15% and no mortality. The median operative time was 100 min and conversion to open procedure was necessary in 2.1%. Conversion for cases of splenomegaly was only 5.7%. The median hospital stay was 3 days. CONCLUSIONS Laparoscopic splenectomy is a safe procedure with acceptable morbidity. A laparoscopic approach for splenomegaly is feasible. Patients and Methods Study design

Long-term Clinical Results of Laparoscopic Splenectomy for Surgical Disease of the Spleen: Recent Outcomes

“…One patient each experienced wound hematoma, gastrointestinal bleeding, and cerebral infarction. Pattenden et al 20 reported an overall complication rate of 15% ( 20 In this study, the mean spleen weight was 294.9 g (range, 31∼2,564 g). The maximum spleen size was 30 cm in length and 22 cm in width.…”

“…[19][20][21] This study had longer operation time than earlier studies owing to the delicate and careful handling during LS to minimize surgical complications and avoid open conversion in difficult cases that were indicated for LS. Further, this study had a relatively small group of 52 patients, which is lower than those of other studies.…”

“…The mean operative time was 203 minutes (range, 115∼475 minutes), while the median postoperative hospital stay was 8 days (range, 3∼28 days). Other studies reported operative times of 100∼ 134 minutes, 10,[19][20][21] as well as hospital stays of 2.8∼5.65…”

Laparoscopic splenectomy in pediatric age: long-term follow-up

“…[1][2][3][4][5][6] Laparoscopic splenectomy (LS) in the pediatric age group is generally accepted as a technically demanding procedure, which needs experience. [7][8][9][10][11] Although widely used, the studies analyzing the outcomes for LS surgeries are very inconclusive in the literature. 12 The purpose of this study is to present the long-term followup results of a case series of children who underwent LS for a variety of hematologic disorders, evaluate possible complications and outcomes.…”

Esplenectomía laparoscópica en la población pediátrica: seguimiento a largo plazo

“…[1][2][3][4][5][6] La esplenectomía laparoscópica (EL) en la población pediátrica está en general aceptada como un procedimiento técnicamente complejo que requiere de experiencia. [7][8][9][10][11] Si bien es un procedimiento ampliamente utilizado, los estudios que analizan los resultados de las EL hallados en la bibliografía no son concluyentes. 12 El objetivo de este estudio es presentar los resultados del seguimiento a largo plazo de una serie de casos de niños sometidos a una EL por diversos trastornos hemáticos, evaluar las complicaciones posibles y los resultados.…”