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PubMed2000

Impact of hematological diagnosis on early and late outcome after laparoscopic splenectomy: an analysis of 111 cases.

BACKGROUND: Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS patients. METHODS: We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided into group 1A, idiopathic thrombocytopenic purpura (ITP) (n = 48) and group 1B, HIV-related ITP (n = 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n = 8), and group 2B, spherocytosis (n = 11); (c) group 3, malignancy (n = 28); and (d) group 4, others (n = 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean follow-up of 24 +/- 18 months. RESULTS: There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity, although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups 3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in >/=75% of patients (group 1A, 82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality was 6.2%, mainly due to deaths in group 4 (six of 22 patients). CONCLUSION: LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a long-term hematological response comparable to the standard results that have been observed in open series.

Chi-Square Distribution↗
PubMed1997

Laparoscopic splenectomy for splenic hamartoma.

Advances in imaging techniques have made pre-operative diagnosis of splenic tumors possible. A case of successful laparoscopic splenectomy for splenic hamartoma is described here and the indications of this technique are discussed.

Hamartoma↗
PubMed1999

Laparoscopic splenectomy: optimal vascular control using the lateral approach and ultrasonic dissection.

BACKGROUND: Intraoperative bleeding is the main complication and main cause of conversion to open surgery during laparoscopic splenectomy (LS). We present the advantages of the lateral approach and the use of the ultrasonic shears (US) for achieving a safer vascular control. METHODS: We have performed a total of 48 LS using several approaches. In our initial experience 10 patients underwent surgery with an anterior approach. In the second series of 18 patients, we used a manually assisted procedure. In the last 20 patients, we employed a technique with a full lateral position. Only three ports have been used. The major part of the dissection was conducted from behind, thus allowing a safer vascular control. The division of short gastric vessels and lower pole vessels was performed using US. The main vascular pedicle was stapled. The spleen was removed through a short Pfannenstiel incision. There were 9 males and 11 females with a mean age of 36 years (range, 18-71 years). Fourteen had immune thrombocytopenic purpura (ITP); two had an HIV-infection-related purpura; two had an autoimmune hemolytic anemia; and two had a spherocytosis. RESULTS: All the 20 LS were completed. The average splenic weight was 274 g (range, 162-1,400 g). In all but one patient, the intraoperative blood loss was less than 60 ml, and was none in six patients (average, 51 ml). In our initial series of 10 patients surgically treated with an anterior approach, the average blood loss was 180 ml, and it was 230 ml in the series of hand-assisted procedures. The average operative time was 127 min (range, 70-220 min), including the time required by the change of position and the Pfannenstiel incision. There was no mortality. All but one patient had an uneventful postoperative course. The HIV-infected patient had a severe postoperative pancreatitis. In those patients with an uncomplicated course, the average postoperative stay was 4.3 days (range, 2-8 days). CONCLUSIONS: The lateral position with a posterior approach to splenic vessels allows for safe vascular control. The use of US results in a gain of time and safety. The average intraoperative bleeding of this series is much lower than that observed in our previous experience and in other published series.

Adolescent↗
PubMed1999

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP). A five-year experience.

BACKGROUND: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for idiopathic thrombocytopenic purpura (ITP), but its long-term efficacy for this disorder is unproved. This report documents the author's 5-year experience with, and long-term follow-up of, LS for ITP. METHODS: Between September 1992 and September 1997, 30 patients with clinical ITP and intractable thrombocytopenia were referred as surgical candidates. Two of them (7%) were converted to open, and the other 28 underwent successful LS. The operative approach evolved from a supine lithotomy to right lateral decubitus position, and the harmonic scalpel became the primary dissection tool in the later part of the study. RESULTS: The 28 successful LS patients constituted the study group. Accessory spleens were identified and resected in six patients (21%). Surgical times and blood loss averaged 2.4 h and 170 cc, respectively. The typical hospital stay was 2 days. Initial reversal of thrombocytopenia and ultimate cessation of oral steroids was achieved in 25 of 28 patients (89%). There were no deaths, but two patients had major complications (bleeding and pneumonia). All but two patients experienced a return to full activity and/or employment by 3 weeks post-LS. In the three cases that failed LS, none had residual splenic tissue on subsequent radionuclide scan. Long-term follow-up (2-60 months) was obtained in 22 of 28 patients (79%). The only death (at 13 months) resulted from oncologic disease. Twenty-one patients had lasting clinical remission of ITP. A positive preoperative response to oral steroids was the best predictor of success. CONCLUSIONS: This 5-year experience with LS supports its use for the surgical treatment of ITP. The procedure is safe and efficacious, resulting in brief hospitalization, minimal recovery time, and excellent long-term results.

Adolescent↗
PubMed2005

Anesthetic management of a patient with beta-thalassemia intermedia undergoing splenectomy: a case report.

A 37-year-old man with beta-thalassemia intermedia (betaTI), a rare disease caused by partial or complete deficiency of beta-globin chain synthesis, fell into a hemolytic crisis. Severe anemia persisted despite frequent transfusions. Therefore, he was scheduled for splenectomy to alleviate the anemia. The preoperative laboratory data showed marked anemia and liver dysfunction. Echocardiography revealed hyperkinetic left ventricular motion and increased cardiac index (CI), indicating a compensatory hyperdynamic circulation induced by persistent, severe anemia. Our strategy during general anesthesia was to keep the hyperkinetic cardiovascular system steady. Hence, the hemodynamic parameters including the CI were measured using a Swan-Ganz catheter, and other physiological parameters were monitored perioperatively. Anesthesia was maintained with balanced anesthesia: isoflurane at low concentrations and fentanyl to avoid cardiovascular depression. Throughout the operation, vital signs were kept stable and the lactate/pyruvate ratio was unchanged, indicating that anaerobic metabolism did not increase. We report successful anesthetic management with attention to hemodynamic changes in a patient with betaTI.

Adult↗
PubMed1998

Simultaneous resection of gastric carcinoma and splenectomy in a patient with polycythemia vera: report of a case.

We report herein the case of a 57-year-old man who underwent resection of gastric carcinoma after being treated for polycythemia vera (PV) for 16 months. He was admitted with gastrointestinal bleeding; barium meal roentogenogram and endoscopic examination subsequently revealed a Borrmann type II carcinoma in the cardia of the stomach with extension into the lower esophagus. Thus, a lower esophagogastrectomy, distal pancreatectomy, splenectomy, and lymph node dissection were performed. Although an insufficiency of the esophagojejunal anastomosis occurred, the patient suffered no hematologic complications in the setting of careful myelosuppressive and antiplatelet coagulation therapy. He is currently doing well 5 years after his operation, with grade 1 performance status and no signs of recurrence or any hematologic complications.

Cardia↗
PubMed2001

Posttraumatic splenic cysts and partial splenectomy: report of a case.

Nonparasitic splenic cysts are uncommon, with only around 800 cases described in the literature. Posttraumatic splenic pseudocysts constitute most such cases and require surgical treatment when symptomatic or voluminous. Recent studies have provided a better understanding of splenic tissue function and the consequent risks of complete resection of the spleen. Hence surgeons should make every possible effort to preserve splenic tissue. Several spleen-conserving surgical treatments have been proposed, especially for treatment of splenic posttraumatic pseudocysts. The authors report the case of a 13-year-old girl who had a posttraumatic splenic cyst with progressive growth. The diameter of the cyst at surgery was 15 cm, and partial splenectomy was performed. The most common spleen-conserving surgical techniques are briefly reviewed.

Abdominal Injuries↗
PubMed1976

Thrombotic thrombocytopenic purpura--remission following splenectomy. Report of a case and review of the literature.

A case of thrombotic thrombocytopenic purpura in which sustained remission followed splenectomy is described. Strong serologic evidence of concurrent infection with Mycoplasma pneumoniae was found in this case. Previously reported cases in which thrombotic thrombocytopenic purpura has been associated with infections are reviewed. An approach to management of this unusual and frequently fetal condition, is suggested, based on a detailed review of the recent literature.

Adolescent↗
PubMed1984

Staging laparotomy and splenectomy in early Hodgkin's disease. No therapeutic benefit.

In a prospective randomized study of treatment for early-stage Hodgkin's disease presenting above the diaphragm, 76 patients had staging by laparotomy (Group I) and 28 had staging by closed techniques (Group II). Treatment consisted of involved-field radiotherapy alone (44 patients), involved-field radiotherapy followed by chemotherapy (38 patients), total nodal radiotherapy alone (15 patients), or total nodal radiotherapy followed by chemotherapy (seven patients). On presentation, both groups had similar clinical features and similar treatment distribution. With similar follow-up (87 months), no significant differences in remission or survival were observed between Groups I and II: remission 59 versus 68 percent; survival 74 versus 92 percent; p value 0.27 and 0.09, respectively. Multiple areas of relapse were more frequently observed in Group I (11 of 32 had relapse) as compared with Group II (none of nine had relapse, p less than 0.082). In Group I, relapse in the abdomen was observed as an isolated event or as part of disseminated relapse in 12 percent of patients compared with 3 percent (one patient) in Group II with abdominal relapse alone. Seven patients in Group I and two patients in Group II died with Hodgkin's disease. Six other patients in Group I died with complete remission of non-Hodgkin's lymphoma (one patient), leukoencephalopathy (one patient), sepsis during chemotherapy (two patients), myocardial infarction (one patient), and cerebrovascular accident (one patient). Three other patients in this group had other secondary malignancies successfully controlled (histiocytic lymphoma, squamous cell carcinoma of the cervix, and malignant schwannoma). No second primary lesions or death with complete remission were observed in Group II. Staging laparotomy with splenectomy in early-stage Hodgkin's disease did not improve the duration of remission or survival or decrease the number of abdominal relapses compared with closed staging.

Actuarial Analysis↗
PubMed1984

Cutaneous extramedullary hematopoiesis following splenectomy for idiopathic myelofibrosis.

A 50-year-old man with idiopathic myelofibrosis had development of extensive cutaneous extramedullary hematopoiesis after undergoing splenectomy. Treatment with hydroxyurea was not effective, but electron-beam irradiation controlled the cutaneous infiltration. This rare clinical manifestation of idiopathic myelofibrosis can be confused with cellulitis, and diagnosis depends upon biopsy.

Aged↗
PubMed1975

Lethal complications of bilateral nephrectomy and splenectomy in hemodialyzed patients.

Routine bilateral nephrectomy and splenectomy (BNS) in uremic patients before transplantation are relatively safe procedures except when there is pre-existing sepsis, diabetes, or severe hypertension. A review of 421 patients undergoing routine pretransplantation BNS reveals that death before transplantation occurs in two definable groups of patients. In our series, the first group, those with juvenile onset diabetes, have a 15.4 per cent pretransplantation mortality (9.6 per cent operative and 5.8 per cent nonoperative) while being maintained on hemodialysis and awaiting transplantation. The second group, nondiabetic patients with other preoperatively definable risk factors such as severe hypertension and infected kidneys, had a 3.25 per cent pretransplantation mortality (1.9 per cent operative and 1.25 per cent nonoperative) while on hemodialysis. Paradoxically, these same factors are used as absolute criteria for pretransplantation nephrectomy at institutions where this operation is not a routine part of the pretransplantation regimen.

Cardiovascular Diseases↗
PubMed1977

Splenectomy: its place in operations for inflammatory disease of the pancreas.

Involvement of the spleen or its vasculature in inflammatory disease of the pancreas may result in life-threatening hemorrhage. Retrospective analysis of six patients having direct splenic involvement and/or occlusion of the splenic vein secondary to pancreatitis or pseudocyst showed that removal of the spleen as a portion of an appropriately timed operation for complications of pancreatitis uniformly resulted in an uncomplicated course and survival (3 patients). Leaving the spleen in place when it was directly involved in a pseudocyst and/or when the splenic vein was occluded resulted in postoperative bleeding, the requirement for reoperation, and death from septic sequelae (2 patients). One patient died of progressive respiratory and renal failure because initial operation was inappropriately delayed. We recommend splenectomy as a portion of an appropriately timed operation for complications of pancreatitis when the splenic vessels are involved and/or when the spleen is directly involved in a pseudocyst or lesser sac collection.

Adult↗
PubMed1980

Splenic artery ligation for trauma. An alternative to splenectomy.

Splenic artery ligation without splenectomy was successfully used to control hemorrhage after blunt injury to the spleen. A review of experimental and clinical reports on splenic artery ligation reveals that this technique is well tolerated because of fairly extensive collateral blood supply to the spleen. The blood supply to the spleen is described in detail.

Adolescent↗
PubMed1980

Partial splenectomy for nonparasitic splenic cysts.

Four cases of partial splenectomy for large, nonparasitic splenic cysts are described. In all four patients it was possible to successfully preserve most of the splenic parenchyma. With the increasing realization of the importance of splenic function, the feasibility of this operative approach to splenic cysts is proposed.

Adult↗
PubMed1981

Prognostic significance of combined splenectomy or pancreaticosplenectomy in total and proximal gastrectomy for gastric cancer.

The prognostic significance of combined splenectomy or pancreaticosplenectomy in total and proximal gastrectomy for gastric cancer was evaluated from the viewpoints of lymph node metastasis in the splenopancreatic region and postoperative long-term survival. The postoperative long-term results were not improved in patients who had undergone combined resection, indicating that the course after total or proximal gastrectomy for advanced gastric cancer is more affected by serosal invasion than lymph node metastasis in the splenopancreatic region. Therefore, combined resection may be of prognostic significance in patients with gastric cancer manifesting lymph node metastasis in the splenopancreatic region but not serosal invasion.

Evaluation Studies as Topic↗