Laparoscopic vs open splenectomy in the management of hematologic diseases

Donini, Annibale; Baccarani, Umberto; Terrosu, Giovanni; Corno, V.; Ermacora, Anna; Pasqualucci, Alberto; Bresadola, F

doi:10.1007/pl00009625

Cited by 86 publications

(64 citation statements)

References 21 publications

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“…3 In the present series, the incidence of hemorrhage is 2.32% among patients undergoing splenectomy; this is comparable with 2.4% reported in the literature. 2 Common sources of hemorrhage following splenectomy include the raw edges of the divided splenic attachments, short gastric or hilar vessel remnants, and surrounding structures such as the pancreatic tail. 4 Post-splenic hemorrhage requiring reoperation is rare yet has been reported as 1.6% in one series.…”

Section: Discussionmentioning

confidence: 99%

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Management of Postoperative Complications Following Splenectomy

Ren

et al. 2013

International Surgery

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Complications of post-splenectomy, especially intra-abdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. The objective of this study was to investigate the cause, prompt diagnosis, and outcome of the fatal complications after splenectomy with a focus on early diagnosis and management of hemorrhage after splenectomy. The medical files of patients who underwent splenectomy between January 1990 and March 2011 were reviewed retrospectively. The cause, characteristics, management, and outcome in patients with post-splenectomy hemorrhage were analyzed. Fourteen of 604 patients (1.19%) undergoing splenectomy had intraperitoneal hemorrhage: reoperation was performed in 13 patients, and 3 patients died after reoperation, giving the hospital a mortality rate of 21.43%; whereas, 590 of 604 patients (98%) had no hemorrhage following splenectomy, and the mortality rate (0.34%) in this group was significantly lower (P , 0.001). The complications following splenectomy, including pneumonia pancreatitis, gastric fistula, gastric flatulence, and thrombocytosis, in patients with postoperative hemorrhage were significantly higher than those without hemorrhage (P , 0.001). According to the reasons for splenectomy, 14 patients with post-splenectomy hemorrhage were grouped into two groups: splenic trauma (n ¼ 9, group I) and portal hypertension (n ¼ 5, group II). The median interval between splenectomy and diagnosis of hemorrhage was 15.5 hours (range, 7.25-19.5 hours). No differences were found between groups I and II in terms of incidence of postoperative hemorrhage, time of hemorrhage after splenectomy, volume of hemorrhage, and mortality of hemorrhage, except transfusion. Intra-abdominal hemorrhage after splenectomy is associated with higher hospital mortality rate and complications.

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Section: Discussionmentioning

confidence: 99%

“…Intraperitoneal hemorrhage is a fatal complication following splenectomy. [1][2][3] It is associated with surgical manipulation and hematologic coagulation. For prompt management of bleeding, it is important to make the diagnosis promptly by carefully observing the clinical manifestation, monitoring the blood hemoglobin level, and imaging with ultrasonography.…”

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confidence: 99%

Management of Postoperative Complications Following Splenectomy

Ren

et al. 2013

International Surgery

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“…59,141 No case series compared splenectomy with either a nonsurgical form of treatment or observation. In 4 other case series, only collection of perioperative data was performed prospectively 91,114,120,139 ; the remaining 122 case series were retrospective analyses. The numbers of case series and patients analyzed for each of the different outcomes are presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications

Kojouri

Vesely

Terrell

et al. 2004

Blood

590

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“…Die präoperati-ve Lokalisationsdiagnostik von akzessorischen Organen wird daher von den meisten Chirurgen nicht routinemä-ûig eingesetzt. Neuere Studien berichten über eine Detektionsrate von akzessorischen Milzen von 15±25 % bei der laparoskopischen Splenektomie, die mit den Zahlen der offenen Splenektomie vergleichbar sind [16,25,41,54]. Diese verbesserten Daten sind sehr wahrscheinlich sowohl durch eine erhöhte Aufmerksamkeit hinsichtlich dieser Problematik während der Operation als auch durch den laparoskopischen Vergrö-ûerungseffekt bedingt.…”

Section: Indikationen Zur Splenektomieunclassified

“…Sie vergleichen auf retrospektiver Ebene die laparoskopische Gruppe gegenüber einem historischem Kontrollkollektiv [16,47] oder gleichzeitig offen-chirurgisch operierten Fällen [41,54,65].…”

Section: Vergleichende Studien Zwischen Laparoskopischem Und Offenem unclassified

Die laparoskopische Splenektomie: Neue Techniken und Indikationen

Rosin

Brasesco

Rosenthal

2001

Chirurg

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Over the recent years laparoscopic splenectomy has become the preferred approach for the treatment of many conditions requiring splenic removal. At first limited to small spleens and to benign hematologic disorders, this procedure is now used for a variety of indications. Enlarged spleens are possible to be removed laparoscopically, although this is still a demanding procedure. Two factors facilitated the technique and contributed to its wide acceptance: 1) Change in the technique originally used, by positioning the patient in right lateral decubitus, and approaching the spleen from a postero-lateral direction. 2) The development of new technologies to dissect and divide tissues and vessels, including the ultrasonic shears and the laparoscopic linear stapler. In this article we review the current indications for laparoscopic splenectomy, as well as the techniques to accomplish this procedure.

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Laparoscopic vs open splenectomy in the management of hematologic diseases

Abstract: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach. The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.

Cited by 86 publications

References 21 publications

Management of Postoperative Complications Following Splenectomy

Management of Postoperative Complications Following Splenectomy

Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications

Die laparoskopische Splenektomie: Neue Techniken und Indikationen

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