2 research outputs found
Experience with laparoscopic splenectomy
Background/Purpose: The laparoscopic splenectomy (LS) often
is adopted to treat children affected by hematologic
diseases. Many of the pitfalls of LS are related to the 2
steps—dissection and extraction. Although various methods
have been adopted, the conversion rate still is too high
during the learning curve period. The authors analyse their
experience in 54 laparoscopic splenectomies performed by
their teams in 3 European countries.
Methods: From 1995 to 1999, 54 children underwent laparoscopic
splenectomy, 4 of whom also underwent a concomitant
cholecystectomy. There were 29 girls and 25 boys with
ages ranging between 4 and 19 years (median, 8.1 years). All
patients underwent an elective laparoscopic splenectomy:
Thirty children had hereditary spherocytosis, 13 had an idiopathic
thrombocytopenic purpura, 10 were affected by a b
thalassemia, and 1 child had sickle cell disease.
Results: Mean operating time was 140 minutes (range, 100 to
250 minutes). Hospital stay ranged from 2 to 6 days (median,
3 days). In 7 patients the spleen was removed through a 7-cm
minilaparotomy; in another 46 cases the spleen was captured
into an extraction bag, fragmented, and then removed
through the umbilical or left orifice. There was one conversion
to open surgery because of a camera failure during the
operation.
Conclusions: On the basis of our experience we believe that
the operating time of LS is still too long compared with open
surgery, and the extraction phase still not simple enough. A
perfect control of hemostasis is fundamental because severe
complications can arise from even a slight bleeding episode.
It also is very important to search for and remove any
accessory spleens. In our series this occurred in 7 patients,
one of whom had 3 accessory spleens. The laparoscopic
approach is today a good alternative to open splenectomy