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Chirurgia 2001 April;14(2):73-6

language: Italian

Combined laparoscopic splenectomy and cholecystectomy for hereditary spherocytosis

Romano F., Caprotti R., Franciosi C., Porta G., Real G., Musco F., Colombo G., Uggeri F.


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Background. Hereditary spherocytosis is the most common red blood cell membrane disorder and it is often associated with hemolytic crisis and premature cholelithiasis. Splenectomy is the only effective therapy for this disorder and often it is performed combined with cholecystectomy. Conventional surgery required a wide upper abdominal incision for the correct exposure of gallbladder and spleen. During last years both laparoscopic cholecystectomy and splenectomy have been safely performed worldwide.
Methods. Personal experience about 8 patients (2 male and 6 females with an average age of 13 years) undergone combined laparoscopic splenectomy and cholecystectomy for hereditary spherocytosis is reported. The patient was placed in supine position with a five-trocars technique. Cholecystectomy was performed first, then splenectomy was achieved and the spleen removed by morcelation in a retrieval bag (6 cases) or via a 4-5 cm left subcostal incision (2 cases).
Results. No one patient required conversion to open technique or blood transfusion, with mean blood loss of 170 ml, mean operative time of 195 minutes and mean spleen size of 14.5 cm. Median postoperative hospital stay was 3.5 days. No perioperative mortality or major complications occurred in our series. After a median follow-up of 18 months all the patients show sharp hematological tests improvement.
Conclusions. Despite of low number of cases, combined laparoscopic approach may be considered safe and effective for the treatment of hereditary spherocytosis.

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