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PubMed1997

[Splenectomy for splenomegaly of more than 1000 grams. A retrospective study of 36 patients].

Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospective study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with splenomegaly weighing 1000 g or more, underwent splenectomy at Centre Hospitalier Universitaire Lyon Sud, from January 1st, 1982, to December 31, 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indications for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 patients (42%). All patients had drainage. The mortality and morbidity rates were 5.5% and 20%, respectively. No major septic or thromboembolic complications occurred. There was only one major bleeding complication. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, permanent pain relief in all cases, and immediate correction of hematological cytopenia in 27 cases (75%). We conclude that the large weight of the spleen does not constitute a contraindication to splenectomy, but indications must be carefully selected, and the operative and perioperative management, must be appropriate.

Adult↗

PubMed2001

The ascendance of laparoscopic splenectomy.

The application of laparoscopic techniques for abdominal procedures has been achieved with varying success. The general acceptance of laparoscopic splenectomy (LS) may be hindered by its infrequent performance and difficulty in manipulating the spleen. A retrospective review of splenectomies performed for primary splenic pathology was done to assess the role and outcome of LS. One hundred fifty LSs were performed from July 1995 through September 1999. Over that time period the proportion of LS performed increased steadily from 17 to 75 per cent of all splenectomies. The primary indications for splenectomy included immune thrombocytopenic purpura in 75 (50%), lymphoma/leukemia 36 (24%), and splenomegaly 19 (13%). There were 86 females and 64 males. Immediately before operation 36 patients (4%) had a platelet count <50,000/ mL, and 24 patients (16%) a hemoglobin <10 mg per cent. The mean operative time was 161 minutes with an average blood loss of 138 cm3 (<50-800). The mean morcellated weight of the entire group was 411 g (33-3300) indicating generally large splenic size. In the 37 patients with splenomegaly the mean weight was 735 g (293-3300). There were two conversions to open splenectomy. Two patients with hematologic malignancy, splenomegaly, and cytopenias died from overwhelming post-splenectomy sepsis (1.3%). Morbidity occurred in 14 (9%) with the most common complication being pancreatitis in seven (5%). The median length of postoperative stay was 2.4 days (range 1-5). In summary LS has rapidly replaced the open approach for nearly all elective splenectomies in adults and children. When performed with the patient in the lateral position it can be accomplished with minimal morbidity, even in complex patients, including those with splenomegaly.

Adolescent↗

PubMed2000

Splenectomy for idiopathic thrombocytopenic purpura: a five-year retrospective review.

Idiopathic thrombocytopenic purpura is a condition that is characterized by persistently low platelet counts. Idiopathic thrombocytopenic purpura results from splenic sequestration and accelerated platelet destruction mediated by antiplatelet antibody. Most cases arise in previously healthy patients, mostly women ages 20 to 40. Clinical symptoms consist of bruising, petechiae, mucosal bleeding, menorrhagia, and intracranial bleeding. Platelet-associated immunoglobulin G can be detected in 90 per cent of patients. Therapy for adults and children is somewhat different. Splenectomy in adults should be considered in patients who fail to respond to steroids, develop thrombocytopenia after taper, or develop steroid toxicity. Ninety per cent of children will maintain normal platelet counts in 9 to 12 months. Some will recover spontaneously without medical therapy. Splenectomy in children is recommended if idiopathic thrombocytopenic purpura persists for more than one year or fails to respond to steroids. Our purpose was to determine whether management of idiopathic thrombocytopenic purpura in patients who undergo splenectomy at our institutions is appropriate and effective. We undertook a 5-year retrospective review of 27 patients with idiopathic thrombocytopenic purpura which have undergone splenectomy. All of the 27 patients were referred to surgeons after initial medical management. The patients were divided into two groups on the basis of length of therapy: longer than 6 months and less than 6 months. The longer than 6 months group contained 15 patients. This group had a postoperative complication rate of 40 per cent. Those in the group with <6 months therapy had a complication rate of 7 per cent. Average follow-up for all patients was 20 months. Eighty-eight per cent of the patients had complete response. Three per cent had a partial response with platelet counts >50,000. The partial response group did not respond well to preoperative steroid boluses with a great rise in platelet counts. Eighteen per cent of patients received platelet transfusions. Sixty per cent of the transfusions were given for inappropriate reasons. A large percentage of our patients had prolonged medical therapy before splenectomy. The inappropriate use of platelets was a common error in management. Patients treated for more than 6 months had more postoperative complications. An initial increase in platelets after steroid bolus is a good indicator for favorable response to splenectomy. We conclude that splenectomy is a safe and effective method of treatment for idiopathic thrombocytopenic purpura with no deaths or postsplenectomy sepsis to date.

Adult↗

PubMedDate not supplied

Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach.

BACKGROUND/AIMS: The role of splenectomy in the surgical management of gastric carcinoma is controversial and there is no consensus of opinion regarding the therapeutic value of splenectomy. The aim of this study was to search for possible metastasis to lymph nodes in the splenic hilum or along the splenic artery to avoid unnecessary splenectomy and to determine its indication. METHODOLOGY: The clinical records of 204 patients who underwent total gastrectomy combined with splenectomy for gastric carcinomas involving the proximal part of the stomach were analyzed. RESULTS: The incidence of nodal involvement to the splenic hilum and/or along the splenic artery was 49 (24.0%) of 204 gastric carcinomas involving the proximal part of the stomach that underwent combined gastrectomy and splenectomy. The characteristics of gastric carcinoma with metastasis to these nodes included a larger tumor, deeper penetration (T3, 4 tumors), a number of lymph node metastasis, and infiltrative type. In T2 cases, all the tumors with cancerous involvement to these nodes showed intraoperative gross serosal change). When the tumor size was less than 40 mm, nodal metastatic rate to the splenic hilum and/or along the splenic artery was very low. CONCLUSIONS: In conclusion, splenectomy should be conducted in T2 cases with gross serosal change and T3, 4 cases. With regard to tumor size, in the cases with a tumor whose size was less than 40 mm, it is possible to preserve the spleen in most cases. In the near future, splenectomy should be clarified precisely by randomized trials in advanced gastric carcinoma.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

Splenectomy enhances liver regeneration through tumor necrosis factor (TNF)-alpha following dimethylnitrosamine-induced cirrhotic rat model.

BACKGROUND/AIMS: We demonstrated that partial splenic embolization for hematological disorders in cirrhotic patients also improved liver function. Therefore, we investigated the mechanism of the beneficial effects of splenectomy on a rat cirrhotic model. METHODOLOGY: 1) Rats were administered DMN (dimethylnitrosamine) after splenectomy (splenectomized DMN rats) or a sham operation (DMN rats). 2) After completion of DMN administration, a tumor necrosis factor-alpha inhibitor (E3330) was administered on the same day as the splenectomy. Histological examination and cytokine expressions were analyzed. RESULTS: The splenectomy apparently reduced liver damage. This may be partially due to the enhancement of liver regeneration since the proliferating cell nuclear antigen labeling index in the DMN-treated liver was significantly increased by splenectomy. Tumor necrosis factor-alpha was down-regulated in the DMN rats, whereas its expression was preserved in the splenectomized DMN rats. There were no apparent differences in the number of Kupffer cells between the splenectomized DMN and the DMN rats, suggesting that the down-regulation of tumor necrosis factor-alpha may contribute to the reduction of Kupffer cells' function. In addition, a tumor necrosis factor-alpha production inhibitor (E3330) significantly reduced the proliferating cell nuclear antigen labeling index after splenectomy. CONCLUSIONS: Splenectomy, in this model, may promote liver regeneration by preserving Kupffer cell function, especially the secretion of tumor necrosis factor-alpha.

Animals↗

PubMed2000

[The effect of splenectomy on circulating endotoxin clearance and tissue distribution of endotoxin in rats].

OBJECTIVE: To study the effect of splenectomy on circulating endotoxin clearance and tissue distribution of endotoxin, and investigate the potential mechanism(s) underlying inflammatory response and multiple organ damage following splenectomy. METHODS: 112 male Wistar rats were randomly divided into two groups: control group (n = 56, included omentectomy and mobilization of the spleen), and splenectomy group (n = 56). The latter was further sub divided into 10-min, 0.5-, 1.5-, 4-, 12-, 24-hour groups after endotoxin challenge. Tissue and systemic blood endotoxin concentrations were measured using the chromogenic limulus amebocyte lysate (LAL), which was modified by perchloric acid (PCA) pretreatment for samples. Liver function parameter and lung tissue myeloperoxidase (MPO) were also measured. RESULTS: After endotoxin administration, plasma endotoxin concentrations were higher in splenectomized rats than in controls at 10 minutes and 0.5 hour (P < 0.01). Endotoxin clearance was delayed in liver and lung in animals after splenectomy. MPO values of the control group were significantly higher than those of splenectomy groups (P < 0.01). CONCLUSION: Splenectomy can lead to impairment of intravascular clearance of endotoxin and endotoxin accumulation in liver and lung. Endotoxin accumulated in local sites may be involved in the development of inflammatory response and multiple organ dysfunction following splenectomy.

Animals↗

PubMed2002

[Laparoscopic splenectomy--personal experience].

The authors present an account on their own experience with laparoscopic splenectomy which is used at the First Surgical Clinic, First Medical Faculty and General Faculty Hospital in Prague since 1996. In 1996 to 2002 the authors performed at the Surgical Clinic a total of 66 splenectomies. This number included on account of injury of the spleen, tumour or cyst 12 splenectomies by the open route. The remaining ones were indicated for haematological reasons in collaboration with the haematological department of the First Medical Clinic of the First Medical Faculty and General Faculty Hospital in Prague and the Institute of Haematology and Blood Transfusion in Prague. 23 splenectomies for haematological reasons were made by the classical open route. In 31 patients the splenectomy was performed by the laparoscopic route. In all haematological reasons were involved. In the group operated at the First Surgical Clinic LSE was indicated because of ITP 15x, for spherocytosis 8x, for haemolytic anaemia 7x, for eliptocytosis 1x. In eight patients at the same time laparoscopic cholecystectomy was performed. In the group subjected to classical splenectomy infection in the surgical wound was recorded in 11%, re-operations on account of a suppurative complications in the abdominal cavity were made in 13% and on account of haemorrhage in 11%. In the group of laparoscopic splenectomies the authors did not record infection at the site of the inserted trocars, there were no suppurative complications in the abdominal cavity. In four laparoscopic operations the authors converted the operation on account of haemorrhage four times (11%), once on account of major adiposity of the omentum, in five postoperative revision on account of haemorrhage was necessary (16%), incl. one case of profuse haemorrhage. Therefore the authors sought a way how to prevent haemorrhage. Based on their own experience they recommend to apply clamps to the trunk of the lienal artery. The time of operation was reduced by the application of clamps to the lienal artery to 60-80 mins. and the peroperative blood losses dropped to 20-30 ml. The morbidity declined and the patients are discharged into domiciliary care on the 4th day after operation, to be on the safe side. No late complications of the operation were recorded.

Humans↗

PubMed2003

Role of splenectomy in chronic idiopathic thrombocytopenic purpura.

AIM OF THE STUDY: To evaluate the usefulness of splenectomy and factors which predict long term remission in chronic idiopathic thrombocytopenic purpura (ITP). METHODS: We reviewed the data of 364 patients diagnosed as chronic ITP between January 1983 to December 1996 of whom 71 patients underwent splenectomy. The patients were followed up for an average period of 58 months and the short and long term response to splenectomy were analyzed at the end of one month and 60 months, respectively. RESULTS: At the end of one month after splenectomy, 82% had complete response, 7% partial response and 11% had no response. At the end of 60 months, 42% maintained complete response, 7% partial response, 34% had no response and 17% were lost to follow up. The results were statistically evaluated by using non-parametric test (Chi-square test) to age, sex, platelet count prior to treatment, initial response to steroids, time interval between diagnosis and splenectomy and post-operative platelet count. Of these factors only preoperative response to steroids (p value = 0.018303) and postoperative platelet count (p value = 0.013536) were found to be significant, statistically to predict long term remission. Age, sex, initial platelet count and time interval between diagnosis and splenectomy didn't seem to be statistically significant. CONCLUSION: This study suggests, that patients with an initial complete response to steroids and a post-operative platelet count > 300 x 10(9)/L at the time of discharge were associated with a long term remission. Splenectomy in ITP is a safe procedure with minimal morbidity and mortality and gives a good long term remission in steroid- failure patients with chronic ITP.

Adolescent↗

PubMed1992

Effects of splenectomy on portal pressure in short- and long-term portal hypertensive rats.

Different hemodynamic patterns were noted in short- and long-term portal hypertensive rats, induced by partial portal vein ligation (PVL) performed two weeks and six months earlier. In order to investigate the effect of splenectomy on the portal pressure of portal hypertensive rats with different hemodynamics, an operation was performed on these two groups of animals and the portal pressure measured thereafter at different time points. Splenectomy in the short-term group produced an immediate, but transient, drop in portal pressure from 14.1 +/- 2.7 to 11.0 +/- 3.0 mmHg, which bounced back to pre-splenectomy values in 20 seconds. Two weeks later, the portal pressure in these splenectomized rats was 15.2 +/- 4.2 mmHg, which was indistinguishable from that of the pre-splenectomy condition of the short-term group. However, after an additional two weeks, portal pressure in the splenectomized rats rose to 16.4 +/- 2.1 mmHg, which was significantly higher than that of the pre-splenectomy condition of the short-term group. This difference in portal pressure became even more pronounced at six months. Sustained portal hypertension was observed in the long-term group, but the pressure was significantly lower than that in the short-term group. Splenectomy in the long-term group produced neither an immediate drop nor a delayed rebound in portal pressure. We conclude that splenectomies in portal hypertensive rats at different stages of disease produce different effects.

Animals↗

PubMed1991

Posttraumatic splenectomy does not influence human peripheral blood mononuclear cell subsets.

The immunological and functional consequences of splenectomy in patients with severe trauma are still controversial. In addition to the higher incidence of bacterial infections, including the post-splenectomy sepsis syndrome, alterations of the peripheral blood mononuclear cells (PBM) have been described in patients after splenectomy. We studied the effects of splenectomy in severely injured patients on the number of PBM subsets 30-80 (median 55) months after splenectomy. Compared to a control group of patients with a similar age and a similar severity of trauma there was no significant difference between splenectomized and non-splenectomized patients regarding the absolute and relative numbers of monocytes, B cells, T cells, CD4+ cells, CD8+ cells, NK cells, CD57+/CD8+ cells and CD4+/CD8+ cells. The CD4/CD8 ratios were within the normal range. In two trauma patients without splenectomy the CD57+/CD8+ cells were found to be elevated to 635 and 513 cells/mm3 compared to less than 100 CD57+/CD8+ cells in controls. Except for a slight thrombocytosis in the splenectomized patients (p less than 0.05) the differential cell count showed no difference between both groups. Our data thus suggest that, in a controlled study, splenectomy has little if any effect on peripheral blood mononuclear cell subsets, while severe trauma on its own may have a profound long term effect on T cell subsets in some patients.

Adolescent↗

PubMedDate not supplied

Subtotal splenectomy preserving the lower pole in rats: technical, morphological and functional aspects.

PURPOSE: To assess the possibility of preserving the lower pole of the spleen, supplied by the inferior lobar vessels and segmental vessels, or by vessels of the gastrosplenic ligament, in subtotal splenectomy; to study the viability and function of the lower pole of the spleen. METHODS: Thirty-six male Wistar rats were used in this study. Said animals weighed 273-390 g ( 355.2 +/- 30.5 g ), and were randomly distributed into three groups. Group 1 comprised ten animals which were submitted to exploratory laparotomy with spleen manipulation (sham operation). Group 2 comprised 16 animals which were submitted to total splenectomy. Group 3 comprised ten animals which were submitted to subtotal splenectomy, preserving the lower pole of the spleen. Blood was collected from all animals before and 90 days after surgery to measure the levels of cholesterol and triglycerides. The animals were sacrificed 90 days after surgery. Spleens and remaining spleens were removed for macroscopic and microscopic examination. RESULTS: Surgery was performed with no complications in all groups. Six animals died in group 2. Spleens of groups 1 and 2, and lower poles of group 3 were macroscopically viable. Apparent white pulp hyperplasia was observed in group 1. In group 3, slight inflammation and capsular fibrosis were observed at the incision site, as well as diffuse hemosiderosis in the red pulp. Average mass of remaining spleen was 35.84% +/- 4.31%. No significant difference was observed between preoperative and late postoperative lipid levels in groups 1 and 3 (p > 0.05). Late postoperative lipid levels significantly increased in group 2. CONCLUSIONS: Preservation of the lower pole of the spleen (supplied by gastrosplenic vessels or inferior lobar vessels and segmental vessels) was possible with subtotal splenectomy. The lower pole was macroscopically and microscopically viable in all cases. Subtotal splenectomy preserving the lower pole prevented changes in lipid levels, which were observed in rats submitted to total splenectomy. Plasma lipid levels in rats submitted to subtotal splenectomy were similar to those observed in sham operated rats.

Animals↗

PubMedDate not supplied

[Long-term follow-up of children with chronic idiopathic thrombocytopenia after splenectomy].

On the ground of follow-up extended over many years the effectiveness was analysed of splenectomy in 93 children with idiopathic thrombocytopenia. Good and very good results of splenectomy were achieved in 84.95% of the cases treated surgically, in 15.05% no remission developed. In 27 splenectomized children recurrences appeared from 1 to 18 years after splenectomy. In 77.8% of cases the recurrences were transient, while in the remaining children qualified into the group with absent remission recurrences persisted throughout the whole follow-up period. In 3 children with unsatisfactory result of splenectomy accessory spleen was removed during repeated laparotomy, in two of them cure was obtained. No greater complications connected directly with the operation were noted. Severe viral and bacterial infections from 2 to 3 years after splenectomy developed in 3 children (3.23%) in 2 cases they were the cause of death (2.15%). Of decisive importance for good prognosis in children with this disease treated by splenectomy was normalization of platelet count immediately after the operation, preoperative disease duration not longer than 12 months, age below 10 years at the time of splenectomy, female sex, and spleen-liver index over 3.4.

Adolescent↗

PubMed1987

[The effect of splenectomy in immature mice].

Overwhelming postsplenectomy infection in childhood has been investigated extensively, both clinically and experimentally. The immunological change after splenectomy in immature mice is reported in this paper. The studies were carried out in 3-week-old immature mice and in 10-week-old mature mice groups. The immunological change after splenectomy in immature mice were as follows. One week after splenectomy, cellular immunity decreased, so that the phagocytosis of macrophages and the function of granulocytes were decreased. Three weeks after splenectomy, cellular immunity and the function of granulocytes improved but the phagocytosis of macrophages was still at the low level. Cellular immunity, the function of granulocytes and the phagocytosis of macrophages were within normal range 5 weeks after splenectomy. Several previous reports have demonstrated a lower IgM concentration. Tuftsin deficiency and activity decreased in opsonization after splenectomy. We showed the more primitive responses than cellular immunity are also depressed in this paper, that is, splenectomy in immature mice resulted in decrease in the phagocytosis of macrophages and dysfunction of granulocytes.

Animals↗

PubMed1984

The effect of splenectomy on platelet formation and megakaryocyte DNA content in rats.

The DNA content of rat bone marrow megakaryocytes (MK) was studied by Feulgen photometry following splenectomy and sham operation, respectively. The DNA measurements were preceded by acetylcholinesterase staining for identification of the 2N-8N MK. The number of 2N-8N MK decreased to minimum values, while the number of 16N-64N MK increased to maximum values about 4 days following both splenectomy and sham operation. However, the changes were somewhat more pronounced following splenectomy than sham operation. The total MK number did not change significantly. Platelet production, measured by 35S incorporation into platelets, increased during the first 2 days and remained high for 6-7 days, increasing the platelet counts. All values were about normal 30 days after surgery, except for a minor thrombocytosis following splenectomy. The early, highly significant thrombocytosis, following both splenectomy and general surgery, is caused by increased production of platelets due to the surgical trauma. This is caused by a direct action on bone marrow MK by transforming 2N-8N MK into higher ploidy classes. Lack of splenic platelet pooling may influence the grade and duration of the early thrombocytosis after splenectomy. The late, long-lasting, minor thrombocytosis, which occurs after splenectomy but not after sham operation, can be explained by the removal of the splenic platelet pool.

Animals↗

PubMed1983

[Immunological effect of splenectomy in tumor-bearing rat].

UNLABELLED: Immunologic merit and demerit of splenectomy were studied, using experimental model in rat. ANIMALS: SD rat. Tumor: Metastasizing Rat's Mammary Tumor No. 1 (MRMT-1) originally induced by 3-MC administration to SD rat. Experimental study: Splenectomy was done on day before and after subcutaneous inoculation of 200mg of MRMT-1 at the back of 4 week-old female SD rats. Tumor growth following splenectomy and immunological competency of rat's peripheral lymphocytes, spleen cells and thymus cells was investigated and following results were obtained. When splenectomy was done pre-operatively or on the 2nd or 14th day after tumor inoculation, subsequent tumor growth was inhibited, however, when it was done on the 7th day after the inoculation, tumor enhancement and shortening of survival period were observed. When it was done on the 21st day, tumor growth was almost the same as in the rats without splenectomy. The results of cpm values and SI ratio of PHA-induced blastogenesis, and NK-activity indicated that immunological competency of spleen cells of tumor bearers was reduced during the early tumor-bearing period and the late tumor bearing period, while it was increased in the middle tumor bearing period. Tumor growth following splenectomy was considered to be controlled by immunological competency of spleen cells. Thus, it may not be unreasonable that tumor growth is inhibited on some occasions and it is facilitated on other occasions after splenectomy.

Animals↗

PubMed1978

Effects of acute and chronic splenectomy on experimental acute renal tubular lesions.

The first half of this study describes the effects of acute splenectomy on epinephrine-induced ATL in the dog. Renal morphology and hematocrit were compared in 12 dogs without splenectomy (group I), six dogs with antecedent splenectomy (group II), and seven dogs with antecedent splenectomy after splenic contraction was induced by topical application of epinephrine (group III). Splenectomy was performed in groups II and III 20 to 30 min prior to epinephrine infusion; all three groups received equal infusions (4 microgram/kg/min) for 6 hr before the kidneys were harvested. ATL and renal congestion were consistently severe in group I but infrequent and less severe in groups II and III. The second half of this study describes the apparent protective effect of chronic (2-week) splenectomy on epinephrine-induced ATL. Renal morphology and hematocrits were compared in 13 intact dogs (group IV) and 10 dogs splenectomized 2 weeks before the epinephrine infusion (group V). The severity of the ATL and the degree of renal congestion were significantly less in the chronically splenectomized dogs. This chronic protection afforded by acute and chronic splenectomy observed after epinephrine infusion remains unclear.

Animals↗

PubMed1994

Role of lymph node dissection and splenectomy in node-positive gastric carcinoma.

BACKGROUND: In gastric carcinoma the relationship between survival of patients and degree of lymph node dissection is still controversial and there is no agreement about the efficacy of extended lymph node dissection and splenectomy. METHODS: Long-term results after surgery were statistically analyzed in 240 patients who underwent curative gastrectomy with lymph node dissection for node-positive gastric carcinoma from 1975 to 1990. RESULTS: The survival of patients was not significantly different among R1, R2, and R3 dissections, with the 10-year survival rate being 57%, 50%, and 44%, respectively. The survival rate was also not different between R2 and R3, even when the cases were stratified by the level of lymph node metastasis (N1, 66% vs 58%; N2, 28% vs 31%). The survival of patients was not significantly different between cases treated without splenectomy and those treated with splenectomy, with 10-year survival rates being 47% and 26%, respectively. The survival rate was also not different between non-splenectomy- and splenectomy-treated cases, even when the patients were compared in the same level of lymph node metastasis (N1, 60% vs 45%; N2, 23% vs 11%). CONCLUSIONS: In cases of curative gastrectomy the survival time of patients was not influenced by the level of lymph node dissection and splenectomy. For the treatment of node-positive gastric carcinoma (N1, N2) the long-term efficacy of R3 dissection and splenectomy seems limited.

Female↗

PubMed1997

Elective laparoscopic splenectomy for hematologic disorders.

Laparoscopic splenectomy has been reported to be the procedure of choice in selected patients with hematologic disorders. The purpose of this study is to review our experience with laparoscopic splenectomy in this patient population. The charts of all patients with hematologic disorders who presented for laparoscopic splenectomy over a 17-month period were reviewed. Fifteen patients, nine males and six females, aged 12 to 80 years (mean, 49 years) presented for laparoscopic splenectomy. Surgical indications included 13 cases of idiopathic thrombocytopenic purpura and one each of hemolytic anemia and Hodgkin's disease. Splenectomy was performed utilizing a four- or five-puncture laparoscopic technique. For completed laparoscopic splenectomies, the mean operative time was 129 minutes, and the mean estimated blood loss was 232 cc. Mean splenic weight was 210 g. There were no operative deaths. There was a single intraoperative complication, a 1700-cc hemorrhage, and two postoperative complications: pneumonitis and deep venous thrombosis. Overall morbidity was 20 per cent. A single patient (7%) required conversion to laparotomy for completion due to hemorrhage. For patients completed laparoscopically, the mean hospitalization was 1.5 days, and none required parenteral narcotics for pain control after the first 36 hours. Laparoscopic splenectomy for patients with hematologic disorders is a safe and technically feasible procedure. Decreased hospitalization and discomfort are the primary benefits. This technique should be added to the repertoire of surgeons treating patients with hematologic disorders.

Adolescent↗