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Chirurgia 2001 February;14(1):13-6


language: Italian

Laparoscopic splenectomy in the treatment of hematologic disorders of the spleen. Personal experience in adult and pediatric patients

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


Background. Laparoscopic splenectomy has gained increasing acceptance in the surgical management of a variety of splenic disorders, in particular hematologic diseases. Personal experience with 23 patients is reported.
Methods. A male/female ratio of 6/17 with a mean age of 21 years (range 5-49) was observed. Patients underwent this procedure because of ITP in 10 cases, spherocytosis in 8, Cooley's disease in 2 and sickle cell anemia, dyserythropoietic and hemolytic anemia in 1 case each. The patient was placed in supine position using a four-trocars technique. Preoperative splenic artery embolization was not performed in any case. Spleen lower pole and its posterolateral attachments were dissected first, using electrocautery and endoclips. Vascular hilar isolation was achieved with an EndoGIA stapler and the spleen was removed by morcelation within a retrieval bag (19 cases) or via a 4-5 cm left subcostal incision (4 cases).
Results. Two patients required conversion to open technique (conversion rate 7%), because of uncontrolled bleeding from splenic hilum in the first case and technical failure in the other one. Mean operative time was 150 minutes (range 90-240), mean splenic size was 13.5 cm (range 11-20), with weight ranging between 140 and 1060 g and estimated blood loss was 140 mL (75-280). No patient required blood transfusion. Mean postoperative hospital stay was 3.5 days (range 3-8). Postoperative complications occurred in 2 patients (7%), with no mortality rate in this series.
Conclusions. The low complication rate and the advantages of a small abdominal trauma in the postoperative period, such as less postoperative pain, faster hospital discharge and better cosmetic results, makes the laparoscopic splenectomy a sure and efficient approach in hematological disorders with a substantial benefit for the patients.

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