Campos-Campos SF, Lara-Olmedo JL, Cervantes-Cruz J, Licona-Hernández JC, Delgadillo-Teyer G, Garcés-Monterrubio MG

Language: Spanish
References: 15
Page: 75-80
PDF size: 61.89 Kb.

ABSTRACT

Background: We undertook this study to compare the outcome of laparoscopic and open splenectomy in the treatment of hematological diseases.
Methods: This was a comparative study of two groups of patients. The study sample consisted of 37 patients divided into two groups: group I, open splenectomy (OS) and group II, laparoscopic splenectomy (LS). Twenty one consecutive patients with LS were compared to 16 randomized patients selected from clinical records of OS patients. General and specific variables were collected in Microsoft Access database and analyzed in SPSS for Windows statistical program. Statistical analysis was done.
Results: Of 25 women and 12 men (37.2 ± 16.9 years old), 6 had autoimmune hemolytic anemia, 29 idiopathic thrombocytopenic purpura (ITP), and two had Evans syndrome. Patients with ITP had preoperative platelet count of 74.6 ± 64.1/mm³ and patients with autoimmune hemolytic anemia had a preoperative hemoglobin of 10.6 ± 2.9 g/dl. Ten patients had co-morbidity. There were 16 OS and 21 LS. Size of spleen was 13.1 ± 3.7 cm and weight was 178 ± 115 g. Surgical time for OS was 69.3 ± 21.7 min and for LS was 152.8 ± 61.1 min (p ‹ 0.05). Operative bleeding for OS was 300 ± 265 ml and for LS it was 265 ± 198 ml (p › 0.05). One patient in LS group had red cell transfusion and two in the same group had to be converted to OS to reassure hemostasis. Reoperations had to be done in the OS group, two to control bleeding and one with a left lobe hepatic hematoma. There was no mortality. Postoperative platelet count in patients with ITP increased to 246 ± 159/mm³ and hemoglobin in patients with hemolytic anemia increased to 12.1 ± 3.6 g (p ‹ 0.05). Hospital stay in OS was 5.06 ± 3.6 days vs. 2.06 ± 0.26 in LS (p ‹ 0.05). Patients in OS had 30.6 ± 10.5 lost work days vs. 15.5 ± 4.6 in LS group (p ‹ 0.05).
Conclusions: It is possible to treat patients with hematological diseases with LS. LS is time-consuming compared to OS. LS may be the gold standard in treatment of patients with hematological diseases.

REFERENCES

1. Cordera F, Long K, Nagornery D, McMurtry E. Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura: clinical and economic analysis. Surg 2003;134:45-52.

2. 2. Lozano-Salazar R. Herrera-Hernández MF, Vargas-Voráckova F, López-Karpovitch X. Laparoscopic versus open splenectomy for inmune thrombocytopenic purpura. Am J Surg 1998;176:366-369.

3. 3. Jiann-Ming W, I-Rue L, Ray-Hwang Y, Sen-Chang Y. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 2004;187:720-723.

4. 4. Minkes R, Lagzdins M, Langer J. Laparoscopic versus open splenectomy in children. J Pediatr Surg 2000;35:699-701.

5. 5. Winslow E, Brunt M. Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with emphasis on complications. Surgery 2003;134:647-653.

6. 6. Tanoue K, Keishi O, Tomohiko A, Kouzou K, Norikazu G, Norifumi T, et al. Laparoscopic splenectomy for hematologic diseases. Surgery 2002:131:318-323.

7. 7. Glasgow R, Mulvihill S. Laparoscopic splenectomy. World J Surg 1999;23:384-388.

8. 8. Kercher K, Matthews B, Walsh M, Sing R, Backus C, Heniford T. Laparoscopic splenectomy for massive splenomegaly. Am J Surg 2002;183:192-196.

9. 9. Smith L, Luna G, Merg A, McNevin S, Moore M, Bax T. Laparoscopic splenectomy for treatment of splenomegaly. Am J Surg 2004;187:618-620.

10. 10. Park A, Birgisson G, Mastrangelo M, Marcaccio M, Witzke DB. Laparoscopic splenectomy: outcomes and lessons learned from over 200 cases. Surgery 2000;128:660-667.

11. 11. Velanovic V, Muhammad S. Laparoscopic excision of accessory spleen. Am J Surg 2000;180:62-64.

12. 12. Masataka I, Mitsugu S, Shuji T, Masaru K, Masakazu I, Hirofumi Y, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy. Ann Surg 2005;241:208-216.

13. 13. Tanoue K, Hashizume M, Morita M, Migoh S, Tsugawa K, Yagi S, et al. Results of laparoscopic splenectomy for immune thrombocytopenic purpura. Am J Surg 1999;177:222-226.

14. 14. Peters M, Camacho D, Ojeda H, Reichenbach D, Knauer E, Yahanda A, et al. Defining the learning curve for laparoscopic splenectomy for immune thrombocytopenia purpura. Am J Surg 2004;188:522-525.

15. 15. Knauer E, Ailawadi G, Yahanda A, Obermeyer R, Millie M, Ojeda H, et al. 101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders. Am J Surg 2003;186:500-504.