Laparoscopic Splenectomy for Hematological Disorders

Abstract

Objectives: The aim of this prospective study was to evaluate the safety and feasibility of laparoscopic splenectomy (LS) in patients with hematological disorders of the spleen. Subjects and Methods: Between 1999 and 2001, 15 patients (11 female and 4 male), with a mean age of 30 years, underwent LS after preoperative evaluation. If difficulties were encountered in LS, one trocar site incision was enlarged to 7–8 cm to engage the left hand for hand-assisted laparoscopic splenectomy (HALS) and the procedure was completed. Various parameters were reported, including spleen size as assessed by ultrasound scan, postoperative mortality and morbidity rates, accessory spleen removal, conversion rate, operative times and length of hospital stay. LS was successfully completed in 9 patients (60%) and HALS was performed in 4 patients (26.6%). Two patients required conversion to open splenectomy. Results: The mean operative time was 209 min and the mean hospital stay was 8.1 days. The hospital stay was significantly longer among HALS patients than LS patients. The mean age of patients and splenic size were associated with a significantly higher conversion rate. No deaths were attributed to the procedure. Complications occurred in 2 of 15 patients. Accessory spleens were identified in 2 patients. Conclusions: LS is both a safe and feasible procedure, but it requires great technical care to avoid serious complications.

Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Disagreement also exists about the use of preoperative imaging to establish splenic size. Some authors set the boundary at a longitudinal diameter greater than 15 cm [39,78,79], whereas others use a boundary of 16 cm [73], 17 cm [63,72], or 20 cm [42,80].…”

“…Although some data exist to show that LS can be performed safely and successfully for patients with liver cirrhosis, the panelists still considered portal hypertension a contraindication to the laparoscopic approach (LoE 3b [38,79]; LoE 5 [83]). …”

Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies

“…The usefulness of laparoscopic surgery already is well proved for cholecystectomy, esophageal antireflux surgery, and splenectomy for benign diseases [1].…”

Optimizing the technique of laparoscopic splenectomy in children

“…All procedures were performed with the laparoscopic method. Haematological diseases prevailed (n = 66), as they are the leading indication for elective splenectomy in the literature [4][5][6][9][10][11][12][13][14][15][16][17][18][19][20][21]. Patients with hypersplenism accompanying portal hypertension formed another group [6,11,[22][23][24], who had devascularization of the oesophagus and gastric fundus with splenectomy as an alternative to other procedures in recurrent bleeding from oesophageal varices after primary therapy with endoscopic sclerotherapy [6,23].…”