2004, Number 1
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Rev Mex Cir Endoscop 2004; 5 (1)
Laparoscopic splenectomy: Long-term result on a prospective series of 260 patients according to the hematology diagnosis
Balagué C, Targarona EM, Vela S, Alonso V, García A, Pey A, Leija C, Garriga J, Trías M
Language: Spanish
References: 21
Page: 5-11
PDF size: 62.60 Kb.
ABSTRACT
Introduction: Laparoscopic approach has demonstrated to be a safe and efficient procedure in treating hematological diseases that require performing splenectomy, specially when the spleen size keeps normal standard measures (PTI). Nonetheless, and even when the immediate results are promising, there is not enough evidence about the long-term evolution.
Objective: To evaluate the long-term results on a series of 260 patients who had been practiced a laparoscopic splenectomy (LS), according to the hematological indicator that suggested surgery.
Material and methods: From February 1993 to February 2004, 260 LS in 103 men and 157 women with an mean age of 45 ± 19 years old have been practiced. Clinical information was gathered in a prospective way in a data base. The splenectomy indicators included the following diagnosis: idiopathic thrombocytopenic purple (ITP) (n = 116), ITP associated to HIV (n = 9), Evans’ syndrome (n = 6), autoimmune hemolytic anemia (AIHA) (n = 13), inheritable spherocytosis (IS) (n = 19), malignant hematological pathology (n = 68), thrombotic thrombocytopenic purple (TTP) (n = 1), and others (n = 26). The immediate results have been analyzed (operating time, conversion, morbidity and stay), as well as long-term follow-up (analytical results, clinical courses from the reference hematologist, and telephone interviews with both the patients and the reference hematologist).
Results: Immediate Postoperative: The average operating time was of 137 ± 56’ with a conversion index of 6.7%, a postoperative mortality of 0.8% and an average stay of 5 days. The long-term follow-up of 188 cases (75%) was achieved during an average period of 35 months. ITP: follow-up of 87 patients (76%), with remission in 89% of the cases; ITP-HIV: 9 patients were followed (86%), with complete remission in 83% of the cases; Evans’ syndrome: follow-up of 4 patients (67%), with complete remission in 100% of the cases; AIAH: 9 patients were followed (82%), with complete remission in 67% of the cases; IS: follow-up on 13 patients (76%), with a mortality of 22%; others: 18 patients were followed (73%), without presenting mortality. During the follow-up, no cases of sepsis related to splenectomy were detected.
Conclusions: Laparoscopic splenectomy (LS) may be applied in every splenectomy hematological indication, with satisfactory results in the long term.
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