1
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Huettl F, Lang H. [Surgery for primary splenic tumors and metastases of the spleen]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:994-999. [PMID: 37946024 DOI: 10.1007/s00104-023-01978-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
The correct indications for surgical treatment of primary splenic tumors as well as metastases of the spleen are challenging due to the rarity of the various entities. Primary solid splenic tumors include benign lesions, such as hemangiomas, hamartomas and sclerosing angiomatous nodular transformation (SANT) of the spleen. In these cases, surgical treatment is indicated only in the case of inconclusive imaging and after careful consideration of the risk-benefit ratio, even in the case of pronounced symptoms. In contrast, primary angiosarcoma or undifferentiated pleomorphic sarcoma as highly malignant tumors represent an urgent indication for surgery. Although more frequent than primary splenic malignancies, secondary splenic tumors are also not that frequent. Solitary splenic metastases are rare; however, from an oncological point of view they can be treated by resection. In the case of oligometastasis with splenic involvement, splenectomy is used only as part of a palliative concept in cases of pronounced symptoms or in the context of cytoreductive surgery. In general, the laparoscopic approach is to be preferred when the operation is technically feasible as it is associated with fewer pulmonary and infectious complications and a shorter hospital stay. In addition, to reduce the risk of severe infections after splenectomy, the option of partial splenectomy should be considered, especially for benign lesions. A thorough informing of the patient regarding both intraoperative and perioperative risks as well as potential long-term sequelae, especially severe infectious diseases, is an essential component of informed consent before surgery.
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Affiliation(s)
- F Huettl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Lang
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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2
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Gao H, Sun B, Li X, Bai T, Du L, Song Y, Zheng C, Kan X, Liu F. Risk factors for portal vein system thrombosis after partial splenic embolisation in cirrhotic patients with hypersplenism. Clin Radiol 2023; 78:919-927. [PMID: 37634989 DOI: 10.1016/j.crad.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
AIM To determine risk factors for portal venous system thrombosis (PVST) after partial splenic artery embolisation (PSAE) in cirrhotic patients with hypersplenism. MATERIALS AND METHODS Between March 2014 and February 2022, 428 cirrhotic patients with hypersplenism underwent partial splenic artery embolisation and from these patients 208 were enrolled and 220 were excluded. Medical records of enrolled patients were collected. Computed tomography (CT) images were reviewed by two blinded, independent radiologists. Statistical analyses were performed by using SPSS. RESULTS Progressive PVST was observed in 18.75% (39/208) of cirrhotic patients after PSAE. No significant differences in peripheral blood counts, liver function biomarkers, and renal function were observed between the patients with progressive PVST and the patients without progressive PVST. The imaging data showed significant differences in PVST, the diameters of the portal, splenic, and superior mesenteric veins between the progressive PVST group and non-progressive PVST group. Univariate and multivariate analysis demonstrated portal vein thrombosis, spleen infarction percentage, and the diameter of the splenic vein were independent risk factors for progressive PVST. Seventeen of 173 (9.83%) patients showed new PVST; the growth of PVST was observed in 62.86% (22/35) of the patients with pre-existing PVST. Spleen infarction percentage and the diameter of the splenic vein were independent risk factors for new PVST after PSAE. CONCLUSION The present study demonstrated portal vein thrombosis, spleen infarction percentage, and the diameter of the splenic vein were independent risk factors for PVST after PSAE in cirrhotic patients with hypersplenism.
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Affiliation(s)
- H Gao
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - B Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - X Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - T Bai
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - L Du
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y Song
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - C Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - X Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - F Liu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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3
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Baldari L, Boni L, Giuliani B, Cassinotti E. Porto-spleno-mesenteric venous thrombosis after elective splenectomy: a retrospective cohort study. Front Immunol 2023; 14:1216283. [PMID: 37928557 PMCID: PMC10625444 DOI: 10.3389/fimmu.2023.1216283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Elective splenectomy is the main treatment for a wide range of haematological diseases. Porto-spleno-mesenteric venous thrombosis represents one of the most severe complications of this procedure. The aim of this study was to evaluate risk factors associated with development of porto-spleno-mesenteric venous thrombosis after elective splenectomy. Methods All cases of elective splenectomy carried out from April 1st 2017 to January 31st 2023 were included in this single centre retrospective cohort study. Patients' demographics and perioperative data were analysed and correlated with the incidence of postoperative thrombosis. All patients underwent postoperative doppler ultrasound screening for thrombosis. Analysis was performed using SPSS 28, with p-value < 0.05 considered significant. Results Twenty-two patients (10 women, 12 men) underwent splenectomy during the study period. Indications were: immune thrombocytopenia (n: 6), myeloproliferative disorder (n: 6), hereditary spherocytosis (n: 4), thalassemia (n: 1), lymphoma (n: 1), leukaemia (n: 1), other malignancies (n: 3). Six patients developed porto-spleno-mesenteric venous thrombosis and only 2 of them were symptomatic. Patients were treated with anticoagulation therapy with complete resolution. Analysis identified three main factors associated with thrombosis: spleen diameter (p = 0.03), myeloproliferative disorder (p = 0.02), intraoperative platelet transfusion (p = 0.002) and intraoperative red blood cells transfusion (p = 0.009). Conclusion Standardized postoperative screening allows prompt diagnosis and treatment of porto-spleno-mesenteric venous thrombosis even in asymptomatic cases. Patient with splenomegaly and affected by myeloproliferative disorder have a greater risk to develop this complication.
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Affiliation(s)
- Ludovica Baldari
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Boni
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunitá, Univeristy of Milan, Milan, Italy
| | - Beatrice Giuliani
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Cassinotti
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunitá, Univeristy of Milan, Milan, Italy
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4
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Zhu W, Wang X, Lv Y, Chen H, Chen X, Li X, Zhu S, Lin Z, Wang G. Comparison of long-term outcomes of splenectomy with periesophagogastric devascularization and transjugular intrahepatic portosystemic shunt in treating cirrhotic portal hypertension patients with recurrent variceal bleeding. Langenbecks Arch Surg 2023; 408:215. [PMID: 37247018 PMCID: PMC10227160 DOI: 10.1007/s00423-023-02933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Transjugular intrahepatic portosystemic shunt (TIPS) and splenectomy with periesophagogastric devascularization (SPD) are widely used to treat cirrhotic portal hypertension (PH) and prevent variceal rebleeding. However, direct comparisons between these two approaches are rare. This study was designed to compare the long-term outcomes of TIPS and SPD in patients with cirrhotic PH and variceal rebleeding. METHODS The study included cirrhotic PH patients with a history of gastroesophageal variceal bleeding between 18 and 80 years of age who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to January 2022. Patients were enrolled into two groups according to TIPS or SPD was performed. Baseline characteristics were matched using propensity score matching (PSM). RESULTS A total of 230 patients underwent TIPS, while 184 underwent SPD. PSM was carried out to balance available covariates, resulting in a total of 83 patients in the TIPS group and 83 patients in the SPD group. Patients in SPD group had better liver function during 60 months follow-up. Five-year overall survival rates in SPD group and TIPS group were 72 and 27%, respectively, at 2 years were 88 and 86%, respectively. The 2- and 5-year freedom from variceal rebleeding rates were 95 and 80% in SPD group and 80 and 54% in TIPS group. CONCLUSIONS SPD is clearly superior to TIPS in terms of OS and freedom from variceal rebleeding in patients with cirrhotic PH. In addition, SPD improved liver function in patients with cirrhotic PH.
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Affiliation(s)
- Wenfeng Zhu
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiaowen Wang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yun Lv
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
| | - Haoqi Chen
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiaolong Chen
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xuejiao Li
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Shuguang Zhu
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Zexin Lin
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Liver Transplantation, Guangzhou, 510630, China
| | - Genshu Wang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510630, China.
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China.
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5
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Chen Y, Cao G, Qin Q, Tang Y, Wang T, Wan C. A Simple Technique of Tunnel Constructing for Occluding Splenic Vessels During Laparoscopic Splenectomy in Patients with Cirrhosis. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37015064 DOI: 10.1089/lap.2022.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Purpose: Dissecting and ligating the splenic artery is crucial for bleeding control during laparoscopic splenectomy (LS). However, for patients with portal hypertension from liver cirrhosis, it is difficult for identification and ligation because the splenic vessel is circuitous and dilated. The aim of this study was to describe a simple technique of constructing a tunnel behind the tail of the pancreas for occluding the splenic vessels during LS in patients with portal hypertension. Materials and Methods: The clinical data of 61 patients who underwent LS from April 2016 to January 2017 were retrospectively analyzed. In 27 patients, the tunnel construction (TC) behind the tail of the pancreas approach was performed owning to difficulty in dissecting and ligating the splenic artery (TC group), including 17 patients who received the TC method directly and 10 patients who received the TC method after trying to dissect the splenic artery. The remaining 34 patients underwent traditional ligating of the splenic artery (LA group). The peri- and postoperative outcomes of operative time, blood loss, conversion rate, postoperative oral diet intake, postoperative hospital stay, and postoperative complication rate of the two groups were analyzed. All the operations were completed by the same group of surgeons. Results: All 61 operations were successfully completed. Compared with patients in the LA group, patients in the TC group had less blood loss (120.37 ± 40.74 mL versus 162.65 ± 87.47 mL; t = -2.317, P = .024). There was no statistical difference of operative time, conversion rate, complication rate, postoperative hospital stays, and follow-up between the two groups. Conclusions: The technique of constructing a tunnel behind the tail of the pancreas for occluding the splenic vessels was effective and safe in those patients whose splenic artery was difficult to dissect and ligate.
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Affiliation(s)
- Yulin Chen
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guojun Cao
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Qin
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Tang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chidan Wan
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Laparoscopic splenectomy for massive splenomegaly: the "splenic no-touch" technique for hilar control by anterior lienorenal approach. LANGENBECK'S ARCHIVES OF SURGERY 2023; 408:30. [PMID: 36642735 DOI: 10.1007/s00423-023-02800-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/02/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Laparoscopic splenectomy is challenging in patients with massive splenomegaly. The paper describes a technique that overcomes the difficulties one faces while dealing with a massive spleen laparoscopically. METHODS We describe our splenic no-touch technique through the anterior lienorenal approach in patients undergoing laparoscopic splenectomy for massive splenomegaly during a 10-year period from January 2010 to January 2020. RESULTS During the study period, 14 patients underwent laparoscopic splenectomy for massive splenomegaly. Of these, 13 patients had successful laparoscopic completion of the procedure. One patient required conversion for bleed. There were no pancreatic tail injuries during splenic hilar stapling in any patient. The median operative time was 170 minutes (140-225). The median blood loss was 50 mL (20-600). Two patients required blood transfusions. There was no other morbidity or mortality. The median postoperative stay was 2 days. CONCLUSION The splenic no-touch technique using the anterior lienorenal approach for laparoscopic splenectomy is safe and feasible in patients with massive splenomegaly. Preoperative imaging enables optimal port placement and procedure ergonomics.
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7
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Kang D, Zhao D, Jiang X, Li D. Isolated splenic metastasis from primary fallopian tube carcinoma and the application of laparoscopic splenectomy: a case report and literature review. Front Oncol 2023; 13:1079044. [PMID: 37207138 PMCID: PMC10189115 DOI: 10.3389/fonc.2023.1079044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Metastases to the spleen from various non-hematologic malignancies are generally not a common clinical event and usually indicate the late dissemination of disease. Solitary splenic metastases from solid neoplasm are extremely uncommon. Furthermore, solitary metastasis to the spleen from primary fallopian tube carcinoma (PFTC) is extremely rare and has not been reported previously. We report a case of isolated splenic metastasis in a 60-year-old woman, occurring 13 months after a total hysterectomy, a bilateral salpingo-oophorectomy, a pelvic lymphadenectomy, a para-aortic lymphadenectomy, an omentectomy, and an appendectomy were performed for PFTC. The patient's serum tumor marker CA125 was elevated to 49.25 U/ml (N < 35.0 U/ml). An abdominal computed tomography (CT) scan revealed a 4.0 × 3.0 cm low-density lesion in the spleen that was potentially malignant, with no lymphadenectasis or distant metastasis. The patient underwent a laparoscopic exploration, and one lesion was found in the spleen. Then, a laparoscopic splenectomy (LS) confirmed a splenic metastasis from PFTC. The histopathological diagnosis showed that the splenic lesion was a high-differentiated serous carcinoma from PFTC metastasis. The patient recovered for over 1 year, with no tumor recurrence. This is the first reported case of an isolated splenic metastasis from PFTC. This case underlines the importance of serum tumor marker assessment, medical imaging examination, and history of malignancy during follow-up, and LS seems to be the optimal approach for isolated splenic metastasis from PFTC.
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Affiliation(s)
- Dongxue Kang
- Department of Operating Room, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Danyang Zhao
- Department of Emergency, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaodi Jiang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Deming Li, ; Xiaodi Jiang,
| | - Deming Li
- Department of Anesthesiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Deming Li, ; Xiaodi Jiang,
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Rollins Z, Rehman R, Al-Hadidi A, Lapkus M, Novotny N, Brahmamdam P, Metz T, Akay B, Stallion A. Preoperative Splenic Artery Embolization for Massive Splenomegaly in Children: A Single Center Experience. J Laparoendosc Adv Surg Tech A 2022; 32:1249-1254. [PMID: 36445756 DOI: 10.1089/lap.2022.0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Massive splenomegaly in children can complicate minimally invasive splenectomy. Splenic artery embolization (SAE) before splenectomy has been shown to decrease splenic volume, reduce intraoperative blood loss, and decrease conversion rates in laparoscopic surgery. Our objective was to review our recent experience with immediate preoperative SAE in massive splenomegaly for pediatric patients using both laparoscopic and robotic techniques. Materials and Methods: We retrospectively reviewed preoperative SAE outcomes in pediatric patients with massive splenomegaly undergoing minimally invasive splenectomy between January 2018 and July 2021. Results: Four patients, 3 female, ages 5-18 years, had SAE immediately before minimally invasive splenectomy. Two cases were completed robotically, one laparoscopically, and one laparoscopic case required conversion to open. SAE time ranged from 69 to 92 minutes. Time between embolization and surgical start ranged from 26 to 56 minutes, with operative times from 153 to 317 minutes. Estimated blood loss ranged from <10 to 150 mL. Mean length of stay was 3.5 days (range 2-6). Postoperative complications included one patient with ileus and another with concurrent gastritis and urinary tract infection. Splenic size comparisons were difficult to perform due to morselization of the spleen; however, excised spleen weights, measurements, and surgeon's impression suggested decreased size of the spleen after SAE. There were no transfusions, postembolization complications, or deaths. Conclusion: SAE subjectively appears to decrease splenic distension, which should allow for easier manipulation and possibly better visualization of splenic hilar vessels during minimally invasive surgery. Immediate preoperative SAE is safe and feasible and should be considered in pediatric patients with massive splenomegaly.
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Affiliation(s)
- Zach Rollins
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Rafey Rehman
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Ameer Al-Hadidi
- Department of General Surgery, Beaumont Health, Royal Oak, Michigan, USA
| | - Morta Lapkus
- Department of General Surgery, Beaumont Health, Royal Oak, Michigan, USA
| | - Nathan Novotny
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Pavan Brahmamdam
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Terrence Metz
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Department of Radiology, Beaumont Health, Royal Oak, Michigan, USA
| | - Begum Akay
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Anthony Stallion
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
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Schultz BL, Bookbinder LC, Claffey EF, Luedke LK, Delvescovo B, Fubini SL, Radcliffe RM. Treatment and outcomes of two pigs treated for hemoabdomen secondary to splenic disease. Vet Surg 2022; 51:1206-1214. [PMID: 35857027 DOI: 10.1111/vsu.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To report the management and outcomes of two pigs undergoing emergency surgery for hemoabdomen secondary to splenic disease. STUDY DESIGN Case report. ANIMAL Two adult pigs with hemoabdomen and suspected splenic pathology. METHODS Pigs were admitted for several clinical signs including lethargy, inappetence, vomiting, abdominal distention, hypothermia, and tachycardia. Abdominal ultrasound and abdominocentesis led to a diagnosis of hemoabdomen secondary to splenic disease. RESULTS The spleen was confirmed as the source of hemorrhage during midline exploratory celiotomy in both pigs. Splenic rupture resulted from splenic vein thrombosis in one pig and splenic torsion in the other. Complications included intraoperative hemorrhage and intraabdominal adhesion formation. Four years following splenectomy, one pig was euthanized because of widespread small intestinal adhesions causing luminal obstruction, while the other pig was euthanized following a diagnosis of chronic myeloid leukemia. CONCLUSIONS A ventral midline celiotomy provided adequate exposure for splenectomy. The procedure allowed resolution of signs in both pigs. Splenic pathology, such as vessel thrombosis or torsion, may result in splenic rupture and should be considered as a differential in pigs with hemoabdomen.
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Affiliation(s)
- Brooke L Schultz
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lauren C Bookbinder
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Elaine F Claffey
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lauren K Luedke
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Barbara Delvescovo
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Susan L Fubini
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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10
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Tan M, Low HM, Shelat V, Tan CH. Imaging patterns in non-traumatic spleen lesions in adults-a review. Jpn J Radiol 2022; 40:664-677. [PMID: 35099683 DOI: 10.1007/s11604-022-01250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
The spleen is a complex organ involved in multiple physiological processes in the human body. Elective splenectomy is an uncommon operation, and the precise characterization of the lesion should be achieved to determine the risks and benefits of this operation accurately. Given the significant role of the spleen in homeostasis and the potential risks of the surgery itself and following sequelae such as infection susceptibility, accurate recognition, and classification of splenic lesions is required before surgery. This review provides an overview of malignant (e.g., lymphoma, angiosarcoma) and benign (e.g., cysts, hemangioma, hamartoma) splenic lesions that may warrant an elective splenectomy. Images from a cohort of adult patients undergoing isolated splenectomy for non-traumatic indications in a single center are provided. This review highlights the considerable overlap in imaging patterns between splenic lesions, splenic lesions masquerading as lesions in other organs, increased detection of asymptomatic splenic incidentalomas due to improvements in imaging modalities. This review also provides clinical correlations for each lesion, providing additional information to help clinicians differentiate between lesions and accurately identify diseases amenable to surgical management.
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Affiliation(s)
| | - Hsien Min Low
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishalkumar Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Cher Heng Tan
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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11
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Beji H, Bouassida M, Laamiri G, Chelbi E, Nechi S, Touinsi H. Primary splenic lymphoma discovered on massive splenomegaly: A case report. Int J Surg Case Rep 2022; 94:107124. [PMID: 35658295 PMCID: PMC9079000 DOI: 10.1016/j.ijscr.2022.107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Malignant lymphoma occurs in all the systemic organs. Rarely, large B-cell lymphoma is located in the spleen, making the diagnosis difficult. Herein, we report a patient presenting with massive splenomegaly due to LBCL. Splenectomy was essential to assess the diagnosis and to guide postoperative therapeutics. PRESENTATION OF A CASE A 47-year-old woman, with no comorbidities, complained of weight loss and abdominal pain. She had a palpable spleen that extended below the navel. CT scan revealed massive splenomegaly and lymph nodes in the spleen hilum. Splenectomy was performed. Histopathological examination confirmed the diagnosis of large B-cell lymphoma. The postoperative course was uneventful. Three courses of chemotherapy were given. The patient was in remission after a follow-up of 8 months. DISCUSSION Massive splenomegaly can be one of the circumstances of the discovery of large B-cell lymphoma. Splenectomy was then essential to confirm the diagnosis and to guide postoperative therapeutics. It also permits reducing hypersplenism and preventing spleen rupture. In patients with high operative risk, splenic needle biopsy should be taken into consideration. Splenic artery embolization before surgery can also be performed in patients having massive splenomegaly to reduce the spleen volume. We highlight the importance of splenectomy to confirm the diagnosis and to relieve the symptoms. Postoperative chemotherapy is essential to prevent relapses. CONCLUSION Splenectomy is essential in spleen localized large B-cell lymphoma. It permits to confirm the diagnosis, relieve symptoms, and treatment of underlying hematologic malignancies. Postoperative chemotherapy is essential to prevent relapses.
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Affiliation(s)
- Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ghazi Laamiri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Emna Chelbi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia; Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Salwa Nechi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia; Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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12
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Di Mauro D, Gelsomino M, Fasano A, Wajed S, Manzelli A. Elective splenectomy in patients with non-Hodgkin lymphoma: Does the size of the spleen affect surgical outcomes? Ann Hepatobiliary Pancreat Surg 2022; 26:144-148. [PMID: 35168206 PMCID: PMC9136429 DOI: 10.14701/ahbps.21-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
Backgrounds/Aims Splenectomy in patients with non-Hodgkin lymphoma (NHL) is performed to relieve abdominal symptoms, treat hypersplenism or confirm diagnosis. Excision of a very large spleen is technically challenging and data on outcomes of surgery in patients with NHL are scanty. The aim of study was to evaluate the impact of spleen size on the surgical outcome of splenectomy in patients with NHL. Methods Patients with NHL who underwent splenectomy, between 2006 and 2017, were included and divided into two groups: group 1, spleen ≤ 20 cm; group 2, spleen > 20 cm. Surgical approach, operative time, postoperative morbidity, mortality, hospital stay and re-admission rates were retrospectively compared between groups. Non-parametric data were evaluated with the Mann-Whitney U test. Differences in frequencies were analyzed with Fisher's exact test. Results Sixteen patients were included (group 1, 6; group 2, 10). Laparoscopy was successful in three patients of group 1, none of group 2 (p = 0.035), the intraoperative time did not differ significantly between groups. One patient in each group developed postoperative complications. The patient in group 1 died of pneumonia. Median length of stay was 8 days (range, 3-16 days) for group 1, 5.5 days (range, 3-10 days) for group 2, showing no significant difference between the two groups. No patient was readmitted to hospital. Conclusions Spleen size does not affect the outcome of splenectomy in patients with NHL. If a mini-invasive approach is to be chosen, laparoscopy may not be feasible when the spleen size is > 20 cm.
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Affiliation(s)
- Davide Di Mauro
- Department of Upper Gastrointestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom,Corresponding author: Davide Di Mauro Department of Upper Gastrointestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX25DW, United Kingdom Tel: +44-1392-406296, E-mail: ORCID: https://orcid.org/0000-0003-2348-5664
| | | | - Angelica Fasano
- Department of Surgery, Hospital Tor Vergata Roma, Rome, Italy
| | - Shahjehan Wajed
- Department of Upper Gastrointestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Antonio Manzelli
- Department of Upper Gastrointestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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13
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Xiao L, Hu C, Cui H, Li R, Hong C, Li Q, Huang C, Dong Z, Zhu H, Liu L. Splenomegaly in predicting the survival of patients with advanced primary liver cancer treated with immune checkpoint inhibitors. Cancer Med 2022; 11:4880-4888. [PMID: 35599583 PMCID: PMC9761067 DOI: 10.1002/cam4.4818] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND & AIMS Immune checkpoint inhibitors (ICIs) play an increasingly important role in the treatment of primary liver cancer (PLC). Some patients with PLC experience symptoms of splenomegaly. Splenomegaly may affect the efficacy of ICIs due to an imbalance of the immune microenvironment. Currently, there is a lack of evidence on the relationship between splenomegaly and prognosis in patients with PLC treated with ICIs. This study analyzed the relationship between splenomegaly and prognosis in patients with PLC treated with ICIs. METHODS In this retrospective cohort study of 161 patients with PLC treated with ICIs, splenomegaly was diagnosed using computed tomography or magnetic resonance imaging and the impact of splenomegaly on patient survival was analyzed. RESULTS Through univariate and multivariate Cox regression analyses, we determined that splenomegaly was associated with shortened overall survival (p = 0.002) and progression-free survival (p = 0.013) in patients with PLC treated with ICIs. Kaplan-Meier analysis further validated our results. The overall survival and progression-free survival of patients with splenomegaly were significantly shorter than those of patients without splenomegaly (p < 0.01 and p = 0.02, respectively). CONCLUSIONS We concluded that splenomegaly was a predictor of prognosis in patients with PLC treated with ICIs. This is the first study to report this important finding.
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Affiliation(s)
- Lu‐Shan Xiao
- Big Data Center, Nanfang HospitalSouthern Medical UniversityGuangzhouChina,Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Cheng‐Yi Hu
- Big Data Center, Nanfang HospitalSouthern Medical UniversityGuangzhouChina,Department of Infectious Diseases, Guangzhou First People's HospitalSchool of Medicine, South China University of TechnologyGuangzhouChina
| | - Hao Cui
- Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Rui‐Ning Li
- Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Chang Hong
- Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Qi‐Mei Li
- Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Chao‐Yi Huang
- Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Zhong‐Yi Dong
- Department of Radiation Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Hong‐Bo Zhu
- Department of Oncology, The First Affiliated Hospital, Hengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Li Liu
- Big Data Center, Nanfang HospitalSouthern Medical UniversityGuangzhouChina,Department of Infectious Diseases, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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14
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Impact of Underlying Disease and Preoperative Factors on Postoperative Outcomes After Laparoscopic Splenectomy: A Bicentric Retrospective Analysis. Surg Laparosc Endosc Percutan Tech 2022; 32:472-475. [PMID: 35583513 DOI: 10.1097/sle.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the laparoscopic approach is considered the gold standard for elective splenectomy, it is still debated whether the underlying disease affects postoperative outcomes. Given the importance of good patient selection in the early stages of the learning curve for laparoscopic splenectomy (LS), this study aimed to compare the postoperative outcomes following LS for malignant diseases and benign diseases (MDs and BDs). MATERIALS AND METHODS A retrospective review of patients who underwent LS was performed at 2 different institutions between January 2013 and September 2020. Patients were classified into 2 groups based on the underlying BDs or MDs, and the 30 days postoperative outcomes were compared. Risk factors for overall complications were determined using logistic regression analysis. RESULTS LS was performed for BDs and MDs in 51 (67%) and 25 (33%) patients, respectively. The overall morbidity rate and the intraoperative and postoperative complication rates were significantly higher in the MD group (P<0.05). In the univariate analysis, the underlying MD, age above 49.5 years, body mass index >24.9, the long axis of the spleen >16 cm, and spleen weight >600 g were significantly associated with increased postoperative morbidity. CONCLUSION In addition to the underlying disease, preoperative conditions may also affect the complication rates after LS. These findings may be helpful in patient selection, especially in the early stages of the learning curve for minimally invasive splenectomies.
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15
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Alsalman MH, Al Jabr FA, Eraqe ST, Ali SI, Essa A. Splenectomy perspective for hematological disorders: a cross-sectional study in the Eastern Province of KSA. J Taibah Univ Med Sci 2022; 17:774-781. [PMID: 36050951 PMCID: PMC9396056 DOI: 10.1016/j.jtumed.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives Splenectomy is considered a therapeutic modality for several hematological diseases, although complications are possible. This study assessed the effects of splenectomy on various hematological disorders and the roles of prophylactic measures on postoperative outcomes. Methods This was a cross-sectional study performed in KSA on adult patients with underlying non-malignant hematological disorders who had undergone splenectomy. Results This study examined 179 patients with various hematological disorders, 38 (21.1%) of whom had undergone a splenectomy. Of those 38 patients, more than two-thirds (73.7%) had an open splenectomy. The average hospital stay was 2–7 days, and no significant difference was observed between the open and laparoscopic approaches. Approximately 95% of the patients showed overall improvements in their condition after splenectomy. However, 26.3% of patients reported a recurrence or need for further treatment 1 year or more after splenectomy. Approximately 16% of patients had an increased incidence of postoperative infectious complications, particularly patients with sickle cell disease and beta thalassemia. More than half the patients who developed complications had not received vaccination preoperatively, whereas 44.4% of vaccinated patients experienced complications (p = 0.04). Conclusion Splenectomy is considered a universal line of treatment for most non-malignant hematological diseases. Although splenectomy is an effective treatment, the reasons why patients with the same disease can have different responses remains unclear. Infection is a common postoperative complication, and vaccinations are underused. This study emphasizes the roles of patient education, scheduled vaccinations and proper selection of patients in the use of splenectomy for the treatment of non-malignant hematological diseases.
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Affiliation(s)
- Mortadah H. Alsalman
- Internal Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, KSA
| | - Faisal A. Al Jabr
- College of Medicine, King Faisal University, Al-Ahsa, KSA
- Corresponding address: College of Medicine, King Faisal University, Al-Ahsa, Al Hafouf, 31982, KSA.
| | | | - Sayed I. Ali
- Family Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, KSA
| | - Abdallah Essa
- Internal Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, KSA
- Tropical Medicine Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
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16
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Liu Y, Fu Y, Fan L. Endoclip migration after laparoscopic splenectomy combined with pericardial devascularization: Case report and literature review. Int J Surg Case Rep 2022; 92:106806. [PMID: 35158233 PMCID: PMC8850752 DOI: 10.1016/j.ijscr.2022.106806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance Endoclip migration(ECM) after laparoscopic splenectomy combined with pericardial devascularization (LESD) is a rare and dangerous postoperative complication. The emergence of such cases led to our consideration of the timing of use of nonabsorbable endoclips. Case presentation This case report describes a patient with cirrhosis and portal hypertension who underwent LESD. Two years after the operation, an endoclip was found in the fornix of the fundus of his stomach by gastroscopy. Clinical discussion A 66-year-old male patient had a history of liver cirrhosis for 9 years. Two years prior, LESD was performed on this patient in our hospital. This time, due to ‘repeated black stool for 1 month, and hematemesis 1 time’, the patient was admitted to the hospital. A diagnosis of ‘liver cirrhosis with esophageal and gastric variceal bleeding’ was considered. Gastroscopy revealed a fundal foreign body, and upon review of the patient history, the foreign body was found to be a nonabsorbable endoclip. Conclusion Foreign literature has reported cases of biliary endoclip migration after laparoscopic cholecystectomy, but no cases of ECM after LESD have been reported. For such cases, we should consider the timing of the application of nonabsorbable endoclips during vascular devascularization to avoid ECM after the operation. In addition, we should also comprehensively evaluate whether the ectopic endoclips should be removed. This is the first case report of endoclip migration from the lateral gastric cavity to gastric cavity. A patient was found an endoclip in his stomach by gastroscopy after laparoscopic splenectomy combined with pericardial devascularization. The mechanism of endoclip migration from the lateral gastric cavity to the gastric cavity remains unclear and is worth exploring. Through the case report, we should pay attention to the implementation of endoclips in laparoscopic splenectomy combined with pericardial devascularization.
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Affiliation(s)
- Yi Liu
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, China
| | - Yan Fu
- Department of Digestive Endoscopy Room, Second Affiliated Hospital of Kunming Medical University, China.
| | - Ling Fan
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, China
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17
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Giant spleen as a surgical challenge: Case report and literature review. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220312051e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. According to the guidelines of the European Association of
Endoscopic Surgery (EAES), any case where the maximum craniocaudal splenic
diameter exceeds 20 cm is considered as massive splenomegaly. In addition to
metabolic, hematological, and hemodynamic problems enlarged spleen may cause
mechanical difficulties due to the pressure to surrounding organs and
vascular structures. The aim of this paper is to present the surgical
challenges and technique applied in massive splenomegaly, in a patient who
had neglected the importance of regular medical checkups. Case outline. We
present a 62-year-old male patient who was admitted to hospital for
treatment of previously clinically and radiologically verified splenomegaly
but who neglected the importance of regular checkups and medical treatment.
Splenectomy was performed with splenic specimen 38 cm in its maximal
diameter. Conclusion. Taking into consideration all the possible benefits
and possible complications of surgical treatment, including the quality of
life of splenectomized patients, comprehensive preoperative assessment
should be made, and surgical treatment selectively applied.
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18
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Laparoscopic Splenectomy According to Spleen Size: a 19 Years’ Experience Study of a Single Institution. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Guo H, Ba X, Gong P, Wang G, Ma H, Wang L, Wang Q. Abdominopelvic ectopic spleen with a comprehensive imaging examination: a case report. J Int Med Res 2021; 49:3000605211000511. [PMID: 33730926 PMCID: PMC8166395 DOI: 10.1177/03000605211000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ectopic spleen is a rare clinical malformation in which the spleen is relocated from its normal anatomical position to other parts of the abdomen. We report a rare case of abdominopelvic ectopic spleen caused by splenic ligament deficiency. A patient experienced intermittent pain in the left upper abdomen that was progressively aggravated. This was confirmed by comprehensive imaging examinations and postoperative pathology. We also performed a review of the literature on the current state of the field. Our data may help to improve the diagnosis and treatment of ectopic spleen.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Yantai, Shandong Province, China
| | - Peiyou Gong
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Guangzhi Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang, Shandong Province, China
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Liying Wang
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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20
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Trovalusci E, Gasparella M, Pizzato C, Midrio P. The Alexis ® system for laparoscopic splenectomy in pediatric patients. Updates Surg 2021; 73:2315-2319. [PMID: 33877588 PMCID: PMC8606377 DOI: 10.1007/s13304-021-01023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
The laparoscopic splenectomy in pediatric patients is performed worldwide but often the disproportion between size of patients and size of organs requires an extra laparotomic access for spleen removal. The aim of the present study was to evaluate the safety and effectiveness of the Alexis® system to retrieve the spleen without additional laparotomic access. The charts of all patients who underwent splenectomy at our center during the last 5 years were retrieved. In all the cases the Alexis® system was placed in the umbilicus, thru which a 10 mm camera was inserted. Three additional 5 mm standard trocars were inserted. Seven patients, affected by spherocytosis (3), epidermoid cyst (2), idiopathic thrombocytopenic purpura (2) and thalassemia (1), underwent laparoscopic splenectomy at a median age of 10 years (range: 8–17). Median patients’ weight was 32.5 kg (range: 25–71) and spleen size 15 cm (11–18). In all the cases, upon removal of the camera, the retrieval bag was inserted thru the umbilicus under direct view, the spleen retrieved, morcellated, and removed. No conversion nor enlargement of one of the ports nor an extra laparotomic access were required. The patients were discharged on the fifth post-operative day and the cosmetic results were excellent. Removal of the spleen can be safely performed without any additional laparotomy thru the Alexis® system placed in the umbilicus. This system is effective also in case of major patient/organ size disproportion and the final cosmetic aspect is excellent.
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Affiliation(s)
- Emanuele Trovalusci
- Pediatric Surgery, Ca' Foncello Hospital, 31100, Treviso, Italy.,Pediatric Surgery, University of Padua, 35128, Padua, Italy
| | - Marco Gasparella
- Pediatric Surgery, Ca' Foncello Hospital, 31100, Treviso, Italy.,Pediatric Surgery, University of Padua, 35128, Padua, Italy
| | - Cristina Pizzato
- Pediatric Oncology Unit, Ca' Foncello Hospital, 31100, Treviso, Italy
| | - Paola Midrio
- Pediatric Surgery, Ca' Foncello Hospital, 31100, Treviso, Italy. .,Pediatric Surgery, University of Padua, 35128, Padua, Italy.
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21
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Fu X, Yang Z, Tu S, Xin W, Chen H, Li X, Li Y, Xiao W. Short- and long-term outcomes of 486 consecutive laparoscopic splenectomy in a single institution. Medicine (Baltimore) 2021; 100:e25308. [PMID: 33787621 PMCID: PMC8021369 DOI: 10.1097/md.0000000000025308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/06/2021] [Indexed: 01/04/2023] Open
Abstract
Since its introduction in 1991, laparoscopic splenectomy (LS) has become the gold standard in elective spleen surgery in many centres. However, there still lack the report of long-term outcomes of LS with the large-scale cases. The aim of the present study was to analyze the short- and long-term outcomes of LS in a single institution over 16 years, and to compare the perioperative outcomes of totally laparoscopic splenectomy (TLS) and hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.Between November 2002 and December 2018, 486 consecutive patients undergoing elective LS were enrolled in this study, including 222 TLS and 264 HALS. The intraoperative, postoperative, and follow-up data were retrospectively analyzed.The 5 most common indications were hypersplenism (71.0%), immune thrombocytopenia (14.8%), splenic benign tumor (4.5%), splenic cyst (2.9%), and splenic malignant tumor (2.9%). The mean operative time, intraoperative blood loss, and length of stay were 149.4 ± 63.3 minutes, 230.1 ± 225.1 mL, and 6.7 ± 3.2 days, respectively. The morbidity, mortality, reoperation, and conversion rate were 23.0%, 0, 0.4%, and 1.9%, respectively. Portal vein system thrombosis (PVST) was the most frequent complication with an incidence of 19.8%. The incidence of PVST in HALS was higher than that in TLS (23.9% vs 14.9%, P = .013). Compared with TLS, HALS had a shorter operative time (P = .000), lower intraoperative blood loss (P = .000), comparable conversion rate (P = .271), and morbidity (P = .922) for splenomegaly > 17.0 cm. During the follow-up period, the overall respond rate for immune thrombocytopenia was 77.8%, and the esophagogastric variceal bleeding rate was 6.9% in 320 patients with hypersplenism secondary to hepatic cirrhosis.LS is a safe, feasible, and effective procedure with satisfactory short- and long-term outcomes. HALS is a reasonable technique in patients with massive spleens.
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Affiliation(s)
| | | | | | | | - Haiming Chen
- Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xueming Li
- Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery
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22
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Application of Real-Time Augmented Reality Laparoscopic Navigation in Splenectomy for Massive Splenomegaly. World J Surg 2021; 45:2108-2115. [PMID: 33770240 DOI: 10.1007/s00268-021-06082-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the clinical impact and technical feasibility of augmented reality laparoscopic navigation (ARLN) system in laparoscopic splenectomy for massive splenomegaly. METHODS The clinical data of 17 consecutive patients who underwent laparoscopic splenectomy using ARLN (ARLN group) and 26 patients without ARLN guidance (Non-ARLN group) between January 2018 and April 2020 were enrolled. Propensity score matching (PSM) analysis was performed between the patients with and without ARLN guidance at a ratio of 1:1. RESULTS Mean intraoperative blood loss was significantly lower in the ARLN-group than in the Non-ARLN group (306.6 ml vs. 462.6 ml, p = 0.047). All the patients in the ARLN-group achieved successful splenic artery dissection, while surgical success was achieved in 12 patients in the Non-ARLN group (p = 0.044). Postoperative hospital stay was significantly longer in the Non-ARLN group (3.8 days vs. 4.5 days, p = 0.040). CONCLUSIONS ARLN can provide feasible and accurate intraoperative image guidance, and it could be helpful in the performance of laparoscopic splenectomy for massive splenomegaly.
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23
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Bhattacharya P, Phelan L, Fisher S, Hajibandeh S, Hajibandeh S. Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis. Am Surg 2021; 88:38-47. [PMID: 33596106 DOI: 10.1177/0003134821995057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic (n = 202) and laparoscopic (n = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: -82.53 mls, 95% CI -161.91 to -3.16, P = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, P = .51), post-operative complications (OR: .91, 95% CI .40-2.06, P = .82), wound infection (RD: -.01, 95% CI -.04-.03, P = .78), haematoma (OR: 0.40, 95% CI .04-4.03, P = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, P = .36), return to theatre (RD: -.04, 95% CI -.09-.02, P = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, P = .73) and length of hospital stay (MD: -.21; 95% CI -1.17 - .75, P = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes.
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Affiliation(s)
- Pratik Bhattacharya
- Department of General Surgery, 1731Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Liam Phelan
- Department of General Surgery, 156631Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Fisher
- Department of General Surgery, 8947Wye Valley NHS Trust, Hereford County Hospital, Hereford, UK
| | | | - Shahin Hajibandeh
- Department of General Surgery, 8947Wye Valley NHS Trust, Hereford County Hospital, Hereford, UK
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24
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Kuriyama N, Maeda K, Komatsubara H, Shinkai T, Noguchi D, Gyoten K, Hayasaki A, Fujii T, Iizawa Y, Murata Y, Tanemura A, Kishiwada M, Sakurai H, Mizuno S. The usefulness of modified splenic hilum hanging maneuver in laparoscopic splenectomy, especially for patients with huge spleen: a case-control study with propensity score matching. Surg Endosc 2021; 36:911-919. [PMID: 33594584 DOI: 10.1007/s00464-021-08348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/27/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although Laparoscopic splenectomy (LS) have been proven to the standard operation for removal of spleen, the rate of conversion to open surgery is still higher than those of other laparoscopic surgeries, especially for huge spleen. In order to reduce the rate of conversion to open surgery, we had developed LS using modified splenic hilum hanging (MSHH) maneuver: the splenic pedicle was transected en bloc using a surgical stapler after hanging splenic hilum with an atraumatic penrose drain tube. METHODS Between January 2005 and December 2019, we retrospectively assessed 94 patients who underwent LS. MSHH maneuver was performed in 37 patients (39.4%). We compared the intra- and postoperative outcomes between patients with or without MSHH maneuver. To adjust for differences in preoperative characteristics and blood examination, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 29 patients per group. Predictive factors of conversion from LS to open surgery were elucidated using the uni- and multi-variate analyses. RESULTS After the propensity score matching, blood loss (268 ml vs. 50 ml), the rate of conversion to open surgery (27.6% vs. 0%), and postoperative hospital stays (15 days vs. 10 days) were significantly decreased in patients with MSHH maneuver, respectively. Among 94 patients, 19 patients (20.2%) underwent conversion to open surgery. In multivariate analysis, spleen volume (SV) and LS without MSHH maneuver were independent predictive factors of conversion to open surgery, respectively. Additionally, cut-off value of SV for conversion to open surgery was 802 ml (sensitivity: 0.684, specificity: 0.827, p < 0.001). CONCLUSIONS LS using MSHH maneuver seems to be useful surgical technique to improve intraoperative outcomes and reduce the rate of conversion from LS to open surgery resulting in shorten postoperative hospital stay.
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Affiliation(s)
- Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Koki Maeda
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Haruna Komatsubara
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Toru Shinkai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Daisuke Noguchi
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kazuyuki Gyoten
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takehiro Fujii
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroyuki Sakurai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Li Y, Liu Z, Liu C. Efficacy and safety of laparoscopic splenectomy for hypersplenism secondary to portal hypertension after transjugular intrahepatic portosystemic shunt. BMC Gastroenterol 2021; 21:61. [PMID: 33573590 PMCID: PMC7879518 DOI: 10.1186/s12876-021-01647-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic splenectomy (LS) being used after Transjugular intrahepatic portosystemic shunt (TIPS) has not been reported. This report aims to explore the feasibility, safety, and potential efficacy of LS after TIPS hypersplenism secondary to portal hypertension (PHT). Methods We retrospectively reviewed a series of six patients who underwent LS after TIPS for hypersplenism secondary to PHT between 2014 and 2020. The perioperative data and patients’ clinical outcomes were recorded. Results LS was successfully performed in all patients. Hypersplenism was corrected after LS in all six patients. Postoperative prothrombin time, prothrombin activity, international normalized ratio, and total bilirubin showed a trend toward improvement. The preoperative and 1-month postoperative albumin and activated partial thromboplastin levels showed no significant difference. Plasma ammonia level and thromboelastography indicators were ameliorated in two limited recorded patients. No postoperative complications such as subphrenic abscess, portal vein thrombosis, variceal bleeding, hepatic encephalopathy, and liver failure occurred during the 1-month follow-up period. Conclusion LS following TIPS is feasible, safe, and beneficial for patients with hypersplenism secondary to PHT. The following LS not only corrects the hypersplenism, but also has the potential to improve liver function.
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Affiliation(s)
- Yingying Li
- Second Clinical College, Department of Surgery, Chongqing Medical University, 1 Medical College Road, Yuzhong District, Chongqing, China
| | - Zuojin Liu
- Department of Hepatobiliary Surgery, Chongqing Medical University Affiliated Second Hospital, 74 Linjiang Road, Yuzhong District, Chongqing, China.
| | - Chang'an Liu
- Department of Hepatobiliary Surgery, Chongqing Medical University Affiliated Second Hospital, 74 Linjiang Road, Yuzhong District, Chongqing, China
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Platelet safety range before splenectomy for hypersplenism: based on 244 cases of splenectomy in hepatolenticular degeneration patients. Acta Gastroenterol Belg 2021; 84:51-56. [PMID: 33639693 DOI: 10.51821/84.1.943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and study aims To investigate the safety and efficacy of splenectomy for hepatolenticular degeneration (HLD) patients with PLT less than 20 × 109/L. Patients and methods A total of 244 HLD patients with hypersplenism underwent splenectomy. According to the preoperative PLT values, the patients were divided into three groups : group A of 53 patients with PLT < 20 × 109/L ; group B of 92 patients with 20 × 109/L ≤ PLT ≤ 30 × 109/L ; group C of 99 patients with PLT > 30 × 109/L. General information including : blood cell counts, liver function , coagulation function 1 day before sugery and 1, 7, 14 days after surgery ; intraoperative blood loss ; operation time ; vital signs at the beginning, at 60 minutes and the end of the operation. Pressure and blood oxygen ; postoperative drainage ; postoperative complications and mortality. Results Blood cell counts, liver function, and coagulation function were improved after splenectomy in three groups (P<0.05) ; there was no significant difference in blood loss, operation time, vital signs during the operation, postoperative drainage, postoperative complications and mortality between three groups (P>0.05). Conclusion For HLD patients with hypersplenism, it is safe and effective to conduct splenectomy under PLT < 20 × 109/L.
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Rodríguez-Luna MR, Balagué C, Fernández-Ananín S, Vilallonga R, Targarona Soler EM. Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis. World J Surg 2020; 45:465-479. [PMID: 33179126 DOI: 10.1007/s00268-020-05839-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To review the evidence regarding the outcomes of laparoscopic techniques in cases of splenomegaly. BACKGROUND Endoscopic approaches such as laparoscopic, hand-assisted laparoscopic, and robotic surgery are commonly used for splenectomy, but the advantages in cases of splenomegaly are controversial. REVIEW METHODS We conducted a systematic review using PRISMA guidelines. PubMed/MEDLINE, ScienceDirect, Scopus, Cochrane Library, and Web of Science were searched up to February 2020. RESULTS Nineteen studies were included for meta-analysis. In relation to laparoscopic splenectomy (LS) versus open splenectomy (OS), 12 studies revealed a significant reduction in length of hospital stay (LOS) of 3.3 days (p = <0.01) in the LS subgroup. Operative time was higher by 44.4 min (p < 0.01) in the LS group. Blood loss was higher in OS 146.2 cc (p = <0.01). No differences were found regarding morbimortality. The global conversion rate was 19.56%. Five studies compared LS and hand-assisted laparosocpic splenectomy (HALS), but no differences were observed in LOS, blood loss, or complications. HALS had a significantly reduced conversion rate (p < 0.01). In two studies that compared HALS and OS (n = 66), HALS showed a decrease in LOS of 4.5 days (p < 0.01) and increase of 44 min in operative time (p < 0.01), while OS had a significantly higher blood loss of 448 cc (p = 0.01). No differences were found in the complication rate. CONCLUSION LS is a safe approach for splenomegaly, with clear clinical benefits. HALS has a lower conversion rate. Higher-quality confirmatory trials with standardized splenomegaly grading are needed before definitive recommendations can be provided. Prospero registration number: CRD42019125251.
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Affiliation(s)
- María Rita Rodríguez-Luna
- IRCAD, Research Institute against Digestive Cancer, France 1 Place de l'Hôpital, 67000, Strasbourg, France.,Gastrointestinal and Hematological Surgical Unit, Service of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona (UAB) Medical School, Carrer Sant Antoni Ma Claret, 167, 08025, Barcelona, Spain
| | - Carmen Balagué
- Gastrointestinal and Hematological Surgical Unit, Service of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona (UAB) Medical School, Carrer Sant Antoni Ma Claret, 167, 08025, Barcelona, Spain
| | - Sonia Fernández-Ananín
- Gastrointestinal and Hematological Surgical Unit, Service of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona (UAB) Medical School, Carrer Sant Antoni Ma Claret, 167, 08025, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Eduardo María Targarona Soler
- Gastrointestinal and Hematological Surgical Unit, Service of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona (UAB) Medical School, Carrer Sant Antoni Ma Claret, 167, 08025, Barcelona, Spain.
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Bing Y, Sadula A, Xiu D, Yuan C. Laparoscopic middle segment splenectomy for central splenic hemangioma: A case report. Int J Surg Case Rep 2020; 77:925-929. [PMID: 33277219 PMCID: PMC7775971 DOI: 10.1016/j.ijscr.2020.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Laparoscopic middle segment splenectomy for central splenic hemangioma is a new technique. Laparoscopic middle segment splenectomy for central splenic hemangioma is very useful for some selected patients. In patients with splenic artery bifurcation point far from the splenic hilus parenchyma and in those cases where the blood supply of the upper and lower pole splenic segments can be ensured, when the splenic tumor is resected, performing LPS and retaining some upper and lower splenic segments is possible to ensure sufficient residual spleen.
Introduction Laparoscopic surgery plays an important role in the treatment of splenichematologic pathologies and solid lesions. Splenic hemangioma is the most common benign tumor of the spleen. In patients with benign splenic space-occupying lesions, laparoscopic partial splenectomy (LPS) has a lower incidence of postoperative complications than laparoscopic total splenectomy (LTS). Currently, no uniform standard for the indication of LPS is available. Presentation of case Herein, we report a case of hemangioma in a 23-year-old woman treated with LPS. After multidisciplinary evaluation, laparoscopic splenectomy was indicated in this case; upon evaluating the age of the patient and the affected spleen portion, a middle segment splenectomy was proposed, with preservation of the upper and lower pole. The intraoperative frozen section of the specimen was negative for malignancies. Discussion Surgery remains the first choice in the treatment of solid lesions of the spleen. In this case, the volume of splenic hemangioma was large and accumulated in the upper and lower segments of the spleen. After the middle branch of splenic artery was cut off, the tumor was completely contained in the middle of upper and lower ischemic lines splenic segment. We think that the central type of benign splenic space occupying is not an absolute contraindication of LPS. For the patients whose splenic artery bifurcation point is far from the splenic hilus parenchyma and in those cases where the blood supply of the upper and lower poles of the splenic segments can be ensured, when the splenic tumor is resected, performing LPS and retaining some parts of the upper and lower splenic segments is possible to ensure sufficient residual spleen.
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Affiliation(s)
- Yuntao Bing
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China
| | - Abuduhaibaier Sadula
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China.
| | - Chunhui Yuan
- Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, China.
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Santarelli M, Lo Secco G, Celi D, Scozzari G, Pautasso P, De Paolis P. Are there any limits for laparoscopy in splenomegaly? Our experience. Updates Surg 2020; 73:1937-1944. [PMID: 32894407 DOI: 10.1007/s13304-020-00876-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
Laparoscopic splenectomy in the case of massive or supermassive splenomegaly has been associated with higher conversion rates and morbidity. The purpose of our study is to evaluate the feasibility and safety of laparoscopic splenectomy for massive spleens and to identify if there are limits beyond which the laparoscopic approach is not recommended in massive and supermassive spleens. This is a retrospective study of 93 consecutive laparoscopic splenectomies in adult patients performed by a single surgeon, from January 2008 to December 2017. The data collected included the patient's age, sex, ASA, spleen weight, volume and dimension, type of disease, hospital stay, surgical technique, operative time. Median splenic weight was 400 g (range 65-3800 g) and median volume was 1365 cc (range 600-3800). Median operative time was 120 min and the overall conversion rate was 5.4%. Globally, 52 patients (55.9%) had a normal-weight spleen, 25 (26.9%) had massive and 16 (17.2%) had supermassive splenomegaly. In splenomegaly group (n = 41), patient's age, percentage of malignant diagnosis, spleen weight, anteroposterior (AP), medio-lateral (ML) and craniocaudal (CC) diameter, surgical time and conversion rate were significantly higher compared to normal-weight spleen patients. None of the normal-weight spleen patients underwent open conversion, while 5 patients among 41 splenomegalic cases underwent laparotomic conversion (12.2%). Comparing massive and super-massive patients, the latter showed longer operative time and hospital length of stay, and higher conversion rate. We identified as significant cut-off limits for higher conversion risk a spleen weight ≥ 1300 g and a spleen CC diameter ≥ 22 cm. In our experience laparoscopy was the gold standard in the case of spleen weight and diameter equal to or less than 1300 g and 22 cm, but it was safe and feasible also in the case of larger spleens, taking into account the greater risk of conversion.
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Affiliation(s)
- Mauro Santarelli
- Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino "Molinette", SC Chirurgia Generale e d'Urgenza 3, Corso Bramante 88, 10126, Turin, Italy.
| | - Giacomo Lo Secco
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Daniele Celi
- Department of Surgical Sciences, Azienda Ospedaliera San Lazzaro, Alba, Italy
| | - Gitana Scozzari
- Hospital Medical Direction, AOU Città della Salute e della Scienza di Torino "Molinette", Turin, Italy
| | - Patrick Pautasso
- Department of Radiology, AOU Città della Salute e della Scienza di Torino "CTO", Turin, Italy
| | - Paolo De Paolis
- Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino "Molinette", SC Chirurgia Generale e d'Urgenza 3, Corso Bramante 88, 10126, Turin, Italy
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Robot-Assisted Partial Splenectomy for Splenic Epidermoid Cyst. Case Rep Surg 2020; 2020:6245909. [PMID: 32963873 PMCID: PMC7492907 DOI: 10.1155/2020/6245909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/19/2019] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
The splenic cyst is a rare disease with unknown etiology. The inner wall of the cyst has lining epithelium. The cyst can be unilocular or multilocular. According to pathology, it can be divided into four types: epidermoid cyst, dermoid cyst, cystic lymphangioma, and cystic hemangioma. Ultrasound examination is often the first choice for splenic cysts because of its nonradiation, low cost, and convenient examination. The images are mostly cystic masses with clear borders and dark areas without echoes, after the detection of splenic space-occupying lesions by ultrasonography, CT, and MRI. Here, we report robot-assisted partial splenectomy for a splenic cyst. Imaging diagnosis of abdominal CT enhancement: the cystic space-occupying of the spleen is considered. We should improve the preoperative examination and exclude operative contraindications. During the operation, there was about 8 cm of the upper pole of the spleen, and the boundary was clear. There was no obvious abnormality in the exploration of the abdominal viscera. The operation was successful. The operative time was 115 minutes, and the blood loss was 20 ml. On the first day after the operation, the patient took a liquid diet. The time of first anal exhaust was on the second day after operation. The patient was discharged at the fourth day. Postoperative pathology revealed epidermoid cyst. The therapy strategy of the splenic cyst is ambiguous. Better understanding of the splenic segmental anatomy and surgical skills has made minimally invasive partial splenectomy a preferred treatment for splenic cysts. In this paper, we report a case of splenic epidermoid cyst managed successfully by robot-assisted partial splenectomy.
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Deng ZC, Jiang WZ, Chen L, Tang XD, Liu SH. Laparoscopic VS. Open splenectomy and oesophagogastric devascularisation for liver cirrhosis and portal hypertension: A retrospective cohort study. Int J Surg 2020; 80:79-83. [DOI: 10.1016/j.ijsu.2020.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 12/29/2022]
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Cadiere B, Grilli A, Bron D. Comparison of Laparoscopic Splenectomy Outcomes for Benign and Malignant Hemopathies. J Laparoendosc Adv Surg Tech A 2020; 30:1172-1176. [PMID: 32392442 DOI: 10.1089/lap.2020.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Laparoscopic splenectomy for malignant hemopathies has been associated with a higher morbidity than for benign hemopathies. Recent progress in medical and surgical treatment for malignant hemopathies may have improved the outcomes of laparoscopic splenectomy. The purpose of this study is to compare the outcomes of laparoscopic splenectomy for malignant hemopathies (SHM) and benign hemopathies (SHB). Materials and Methods: We retrospectively reviewed all patients with hematological diseases who underwent a non-post-traumatic laparoscopic splenectomy between 2008 and 2019. Patients who suffered splenectomy for a malignant and benign disease were divided into two groups and compared. Results: Fifty patients suffered a splenectomy for hematologic disorder, 19 patients for benign hemopathy, and 31 for malignant hemopathy. SHM group was significantly older, and had more history of abdominal surgery and significantly larger spleens (P < .05). There was no significant difference in terms of operative time (150 versus 146 minutes; P < .8) and blood loss (243 versus 402 mL; P < .26). Hospital stay for SHB and SHM groups was 5.4 and 7.6 days, respectively (P = .19). There was no significant difference in terms of early (10% versus 13%; P = 1) and late complications (0% versus 13%; P = .28). One conversion to open surgery and one perioperative death in each group (P = 1) were reported. Splenectomy effectiveness was 83% and 79% in benign hemopathy and malignant hemopathy groups (P = .91), respectively. Conclusions: Laparoscopic splenectomy for malignant hemopathy shows similar outcomes to laparoscopic splenectomy for benign hemopathy, despite older patients, larger spleens, and more important abdominal surgery history. Higher late morbidity rate after laparoscopic splenectomy for malignant hemopathy may justify a careful follow-up.
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Affiliation(s)
- Benjamin Cadiere
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Arianna Grilli
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Dominique Bron
- Department of Hematology, Institut Jules Bordet (ULB), Brussels, Belgium
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Antoniou SA, Tsokani S, Mavridis D, Agresta F, López-Cano M, Muysoms FE, Morales-Conde S, Bonjer HJ, van Veldhoven T, Francis NK. Insight into the methodology and uptake of EAES guidelines: a qualitative analysis and survey by the EAES Consensus & Guideline Subcommittee. Surg Endosc 2020; 35:1238-1246. [PMID: 32240381 DOI: 10.1007/s00464-020-07494-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Over the past 25 years, the European Association for Endoscopic Surgery (EAES) has been issuing clinical guidance documents to aid surgical practice. We aimed to investigate the awareness and use of such documents among EAES members. Additionally, we conceptually appraised the methodology used in their development in order to propose a bundle of actions for quality improvement and increased penetration of clinical practice guidelines among EAES members. METHODS We invited members of EAES to participate in a web-based survey on awareness and use of these documents. Post hoc analyses were performed to identify factors associated with poor awareness/use and the reported reasons for limited use. We further summarized and conceptually analyzed key methodological features of clinical guidance documents published by EAES. RESULTS Three distinct consecutive phases of methodological evolvement of clinical guidance documents were evident: a "consensus phase," a "guideline phase," and a "transitional phase". Out of a total of 254 surgeons who completed the survey, 72% percent were aware of EAES guidelines and 47% reported occasional use. Young age and trainee status were associated with poor awareness and use. Restriction by colleagues was the primary reason for limited use in these subgroups. CONCLUSIONS The methodology of EAES clinical guidance documents is evolving. Awareness among EAES members is fair, but use is limited. Dissemination actions should be directed to junior surgeons and trainees.
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Affiliation(s)
- Stavros A Antoniou
- Medical School, European University Cyprus, Nicosia, Cyprus.
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus.
- , Athinon-Souniou 11, 19001, Keratea, Athens, Greece.
| | - Sofia Tsokani
- Department of Mathematics, School of Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios Mavridis
- Department of Mathematics, School of Sciences, University of Ioannina, Ioannina, Greece
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | | | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, Sevilla, Spain
| | - Hendrik-Jaap Bonjer
- Department of General Surgery, VU University Medical Center, Amsterdam, Netherlands
| | - Thérèse van Veldhoven
- Executive Office, European Association for Endoscopic Surgery, Veldhoven, Netherlands
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
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Aziret M, Koyun B, Karaman K, Sunu C, Karacan A, Öter V, Çelebi F, Ercan M, Bostancı EB. Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy. Turk J Surg 2020; 36:72-81. [PMID: 32637879 DOI: 10.5578/turkjsurg.4535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
Objectives Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique. Material and Methods A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity. Results No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p <0.05) were higher in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to open surgery. Conclusion Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.
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Affiliation(s)
- Mehmet Aziret
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Bülent Koyun
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Kerem Karaman
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Cenk Sunu
- Clinic of Hematology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Alper Karacan
- Clinic of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Volkan Öter
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Fehmi Çelebi
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Metin Ercan
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Erdal Birol Bostancı
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
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Luo HP, Zhang ZG, Long X, Liu FL, Chen XP, Zhang L, Zhang WG. Combined Laparoscopic Splenectomy and Esophagogastric Devascularization versus Open Splenectomy and Esophagogastric Devascularization for Portal Hypertension due to Liver Cirrhosis. Curr Med Sci 2020; 40:117-122. [PMID: 32166673 DOI: 10.1007/s11596-020-2154-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/12/2019] [Indexed: 10/24/2022]
Abstract
This study was conducted to compare the feasibility, safety and effectiveness of the combined-laparoscopic splenectomy and esophagogastric devascularization (C-LSED) with open splenectomy and esophagogastric devascularization surgery (OSED) in patients with portal hypertension due to liver cirrhosis. From February 2014 to June 2018, 68 patients with portal hypertension were diagnosed as having serious gastroesophageal varices and/or hypersplenism in our center. Thirty patients underwent C-LSED and 38 patients received OSED. Results and outcomes were compared retrospectively. No patients of C-LSED group required an intraoperative conversion to open surgery. Significantly shorter operating time, less blood loss, lower transfusion rates, shorter postoperative hospital stay, lower rates of complications were found in C-LSED group than in C-LSED group (P<0.05). No death and rebleeding were documented in both groups during the follow-up periods of one year. Postoperative endoscopy revealed that varices in the patients of both groups were alleviated significantly from severe to mild, and in a part of cases, the varices disappeared. The final results suggest that the C-LSED technique is superior to open procedure, due to slightly invasive, simplified operative procedure, significantly shorter operating time, less intraoperative bleeding and lower post-operative complication rates. And C-LSED offers comparable long-term effects to open surgery.
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Affiliation(s)
- Hong-Ping Luo
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhan-Guo Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fei-Long Liu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Wan-Guang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Ouyang G, Li Y, Cai Y, Wang X, Cai H, Peng B. Laparoscopic partial splenectomy with temporary occlusion of the trunk of the splenic artery in fifty-one cases: experience at a single center. Surg Endosc 2020; 35:367-373. [PMID: 32052148 DOI: 10.1007/s00464-020-07410-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic partial splenectomy (LPS) for splenic benign space-occupying lesions has been reported by many researchers; however, few studies have described methods to control intraoperative bleeding. Trustworthy experience in LPS with a satisfactory intraoperative hemorrhage control technique is therefore necessary. The current study aims to present our experience in LPS with temporary occlusion of the trunk of the splenic artery for controlling intraoperative bleeding with a large sample of 51 cases and to evaluate the safety, feasibility, and reproducibility of this technique. METHODS Fifty-one patients from August 2014 to April 2019 who underwent LPS in our institution were retrospectively analyzed. Surgical techniques were described in detail. RESULTS All patients had successfully undergone LPS with temporary occlusion of the trunk of the splenic artery. Conversions to open surgery, hand-assisted laparoscopic splenectomies, or blood transfusions were not needed. The operative time was 94.75 ± 18.91 min, the estimated blood loss was 71.13 ± 53.87 ml, and the volume of resected spleen was 34.75 ± 12.19%. The range of postoperative stays was 4-14 days. One female patient (2%, 1/51) suffered from postoperative complications. No perioperative mortality, incision infections, postoperative pancreatic fistulas (POPFs), splenic infarctions, or portal/splenic vein thromboembolic events occurred. CONCLUSION LPS is an effective spleen-preserving surgery. Although there are many other bleeding control methods, temporarily occluding the trunk of the splenic artery was found to be a safe, feasible, and reproducible technique in LPS. The outcomes of this technique and the efficacy of splenic parenchyma preservation are acceptable.
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Affiliation(s)
- Guoqing Ouyang
- Sichuan University, Chengdu, China
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yongbin Li
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Yunqiang Cai
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - He Cai
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Bing Peng
- Sichuan University, Chengdu, China.
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China.
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China.
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Liu P, Li Y, Ding HF, Dong DH, Zhang XF, Liu XM, Lv Y, Xiang JX. A novel preoperative scoring system to predict technical difficulty in laparoscopic splenectomy for non-traumatic diseases. Surg Endosc 2020; 34:5360-5367. [PMID: 32016520 DOI: 10.1007/s00464-019-07327-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) has been proven to be a safe and advantageous procedure. To ensure that resections of appropriate difficulty are selected, an objective preoperative grading of difficulty is required. We aimed to develop a predictive difficulty grading of LS based on intraoperative complications. METHODS A total of 272 non-traumatic patients who underwent LS were identified from a regional medical center. Patients were randomized into a training cohort (n = 222) and a validation cohort (n = 50). Data on demographics, medical and surgical history, operative and pathological characteristics, and postoperative outcome details were collected. Univariate and multivariate analyses of risk factors for intraoperative complications were performed to develop a difficulty scoring system. The Spearman correlation coefficient was used to evaluate the relationship between the difficulty grading score and intraoperative outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the discriminatory power of this scoring system. RESULTS Three preoperative factors (spleen weight, esophagogastric varices, and INR) had a significant effect on operative time, bleeding, and conversion to open surgery. We created a difficulty grading score with three levels of difficulty: low (≤ 4 points), medium (5-6 points), and high (≥ 7 points), based on the three preoperative parameters. The correlation was highly significant (P < 0.01) according to Spearman's correlation. The area under the ROC curve was 0.695 (95% CI 0.630-0.755). The external validation showed significant correlations with the present model, with an AUC of 0.725 (95% CI 0.580-0.842). The comparison between our difficulty score and the previous grading system in the 272-patient cohort presented a significant difference in the AUC (0.701, 95% CI 0.643-0.755 vs. 0.644, 95% CI 0.584-0.701, P = 0.0452). CONCLUSION The present difficulty scoring system, based on preoperative factors, has good performance in predicting the risk of intraoperative complications of LS and could be helpful for enabling appropriate case selection with respect to the current experience of a surgeon.
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Affiliation(s)
- Peng Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - You Li
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Hong-Fan Ding
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ding-Hui Dong
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xue-Min Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jun-Xi Xiang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China. .,National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines? Surg Laparosc Endosc Percutan Tech 2019; 29:178-181. [PMID: 30720696 DOI: 10.1097/sle.0000000000000637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to derive some useful parameters to define the feasibility of laparoscopic splenectomy (LS) in massive [spleen longitudinal diameter (SLD)>20 cm] and giant spleens (SLD>25 cm). Between December 1996 and May 2017, 175 patients underwent an elective splenectomy. A laparoscopic approach was used in 133 (76%) patients. Massive spleens were treated in 65 (37.1%) patients, of which 24 were treated laparoscopically. In this subset of massive spleens, the results of laparoscopic splenectomy in massive spleens (LSM) and open splenectomy in massive spleens (OSM) were compared. The clinical outcome of a subgroup of patients with giant spleens was also analyzed. The LSM group resulted in significant longer operative times (143±31 vs. 112±40 min; P=0.001), less blood loss (278±302 vs. 575±583 mL; P=0.007), and shorter hospital stay (6±3 vs. 9±4 d; P=0.004). No conversions were experienced in the LSM group, and the morbidity rate was similar in both the LSM and OSM groups (16.6% vs. 20%; P=0.75). When considering the subset of 9 LSM patients and 26 OSM patients with giant spleens, the same favorable tendency of the laparoscopic group as regards surgical conversion, blood loss, and hospital stay was maintained. The laparoscopic approach can be successfully proposed in the presence of massive splenomegaly also after a careful preoperative evaluation of the expected abdominal "working space." In experienced hands, LS is safe, feasible, and associated with better outcomes than open splenectomy for the treatment of massive and giant spleen, with a maximum SLD limit of 31 cm.
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Hand-assisted Laparoscopic Splenectomy Advantages Over Complete Laparoscopic Splenectomy For Splenomegaly. Surg Laparosc Endosc Percutan Tech 2019; 29:109-112. [PMID: 30720697 DOI: 10.1097/sle.0000000000000640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is generally applied for splenectomy, However, it also brings some technical challenges, especially for splenomegaly. Hand-assisted laparoscopic splenectomy (HALS) can help to overcome these drawbacks while maintaining the superiority of LS. This study was aimed to evaluate the efficacy and advantage of HALS for splenomegaly. MATERIALS AND METHODS Between January 2014 and November 2017, 91 patients with splenomegaly in 2 surgical centers were randomly assigned to either HALS (n=45) or LS (n=46). The patients' characteristics, intraoperative details, and the postoperative outcomes in both groups were compared. RESULTS Baseline features (sex, age, main diameter, Child-Pugh grade) of both groups had no significant difference (P<0.05). Compared with LS group, the HALS group operation time (141±46 vs. 172±43 min; P=0.001) was shorter, intraoperative blood loss [215 (122.332) vs. 230 (130.740) mL; P=0.026], hospital expenses (5.5±1.5 vs. 6.4±2.4 WanRMB; P=0.022), and conversion rate (1/45 vs. 9/46; P=0.015) were lower. However, there was no significant difference for hospital stay (6.4±2.8 vs. 6.7±3.0 d; P=0.662) and complications (15/45 vs. 12/46; P=0.893) between the 2 groups. In addition, there were no significant differences in postoperative white blood cell (10.6±2.9 vs. 10.9±3.5; P=0.747), AST [61 (47.94) vs. 57 (37.86) U/L; P=0.513], and ALT [68 (54.120) vs. 55 (36.99) U/L; P=0.302] levels. CONCLUSIONS HALS can maximize the benefits for patients, while maintaining the advantages of LS and open splenectomy. It is the ideal surgical treatment for splenomegaly.
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Radkowiak D, Wysocki M, Zychowicz A, Lasek A, Major P, Pędziwiatr M, Budzyński P, Zub-Pokrowiecka A, Budzyński A. Is ITP really a desirable indication for teaching laparoscopic splenectomy? Cohort study. Acta Chir Belg 2019; 119:376-383. [PMID: 30624145 DOI: 10.1080/00015458.2018.1545743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: We aimed to evaluate the outcomes of laparoscopic splenectomy (LS) in patients with immune thrombocytopenic purpura (ITP) compared with operated for other indications. Methods: Retrospective cohort study of patients who underwent LS in 1998-2017. Group 1 consisted of 256 patients operated for ITP, and Group 2 of 231 operated for other indications. Primary outcome was procedure difficulty. Secondary was perioperative course (30 days of surgery). Results: Patients in Group 1 were younger (p < .001) with lower ASA (p < .001). The spleen was larger in Group 2 (p < .001). Operative time was longer in Group 2 [110 (80-150) vs. 90 (65-115) min; p < .001)]. Intraoperative blood loss was greater in Group 2 (p < .001). Conversions were higher in Group 2 (4.76 vs. 6.93%, p = .037), as were intraoperative complications (7.79 vs. 3.91%, p = .048). Morbidity, reoperations and mortality did not differ between groups (respectively, p = .899, .697, and .999). Median length of stay was similar (p = .211). Among the first 10 LSs performed by trainees, 63.66% were done for ITP. Later (after 11+ procedures) this dropped to 48.12% (p = .002). Conclusions: ITP may be a preferred indication for surgeons training for LS. Patients' characteristics and intraoperative factors allow an expectation for a relatively easy and hassle-free operation in those patients.
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Affiliation(s)
- Dorota Radkowiak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
| | - Anna Zychowicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Lasek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
| | - Piotr Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Zub-Pokrowiecka
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
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Koyama R, Minagawa N, Maeda Y, Shinohara T, Hamada T. Splenic marginal zone lymphoma treated with laparoscopic splenectomy: A case report. Int J Surg Case Rep 2019; 65:288-291. [PMID: 31759300 PMCID: PMC6880136 DOI: 10.1016/j.ijscr.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022] Open
Abstract
The authors present a case of splenic marginal zone lymphoma (SMZL), which was successfully treated with laparoscopic splenectomy. SMZL is a rare subtype of indolent B cell lymphoma, and good prognosis is expected by splenectomy alone. Laparoscopic splenectomy is safe and feasible with splenic artery embolization preoperatively, especially in cases with large splenomegaly as seen in our case. Careful postoperative follow-up is required since some patients develop aggressive transformation, and result in worse prognosis.
Introduction Splenic marginal zone lymphoma (SMZL) is rare subtype of malignant lymphoma that is classified as a low-grade B cell lymphoma. Splenectomy is usually chosen for both diagnosis and treatment, which often leads to the resolution of abdominal symptoms and cytopenia. Case presentation We presented the case of a 73-year-old woman who complained of spontaneous perspiration and fatigue. She was referred to our hospital for further treatment of enlarged intraabdominal lymph nodes and splenomegaly. The level of soluble Interleukin-2 receptor was elevated, and malignant lymphoma was suspected. Endoscopic ultrasound fine-needle biopsy of intraabdominal lymph node revealed B cell lymphoma. For a definitive diagnosis, as well as treatment, laparoscopic splenectomy was successfully performed. The histopathological finding was compatible with SMZL. The patient was discharged without any complications and observed to have no recurrence at eight months postoperatively. Conclusion Patients with SMZL is usually expected to have good prognosis with splenectomy. However, careful follow-up is required for aggressive transformation can occur and result in worse prognosis.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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Fachin CG, Amado F, Romaniello G, Oliveira L, Oliveira I, Wolff L, Granella VH, Tsouristakis AI, Agulham M, Dias AI. Open Versus Laparoscopic Splenectomies in Children: A Comparative Study Performed at a Public Hospital in Brazil. J Laparoendosc Adv Surg Tech A 2019; 29:1357-1361. [DOI: 10.1089/lap.2019.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Camila Girardi Fachin
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Fernando Amado
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Leilane Oliveira
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Igor Oliveira
- Medical School, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Lucas Wolff
- Medical School, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Miguel Agulham
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - André I.B.S. Dias
- Department of Pediatric Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Accessory Splenectomy: the Keystone of Success in the Treatment for Refractory Immune Thrombocytopenia. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01949-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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A Systematic Review and Meta-Analysis of Anterior Versus Lateral Approach for Laparoscopic Splenectomy. Surg Laparosc Endosc Percutan Tech 2019; 29:233-241. [DOI: 10.1097/sle.0000000000000627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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45
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Chen Y, Wang J, Ye Q, Wang Z, Weng W, Zhu J. Fast-track care with intraoperative blood salvage in laparoscopic splenectomy. Sci Rep 2019; 9:9945. [PMID: 31289303 PMCID: PMC6617455 DOI: 10.1038/s41598-019-45865-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/06/2019] [Indexed: 12/25/2022] Open
Abstract
Fast-track surgery is claimed to reduce medical morbidity, eliminate the hospitalization needs, and shorten the convalescence period. Intraoperative bleeding as the main complication is also the primary cause of conversion from laparoscopic to open splenectomy. Intraoperative blood salvage can reduce transfusion requirements, decrease the conversion rate to open, and promote fast-tracking in laparoscopic splenectomy (LS). From November 2007 through December 2016 we collected medical data of 115 LS patients. There were three groups: 54 patients receiving routine care (we marks them as Group RT), 33 patients with fast-track care (Group FT), and 28 receiving fast-track care receiving intraoperative splenic blood salvage and autotransfusion (Group FT + ISBS). These medical data are comprised of included three phases (pre-, intra-, and postoperative). There were significant differences (P < 0.05) between RT, FT, and FT + ISBS groups. The hemoglobin level in Group FT + ISBS was significantly higher than in Group RT and Group FT. Comparing the duration of hospital stay of 3 groups, Group RT stayed for a significantly longer time than Group FT and Group FT + ISBS, Group FT + ISBSmuch shorter than Group FT. Comparing the hospitalization expense, GroupFT + ISBS significantly expended less than Group RT and Group FT. Our study shows that laparoscopic splenectomy with fast-track care is feasible, effective, and safe for patients who require splenectomy. Fast-tracking with intraoperative blood salvage improved the fast-track laparoscopic splenectomy procedure.
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Affiliation(s)
- Yan Chen
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jianwei Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qinghuang Ye
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhijiang Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Weihong Weng
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jinhui Zhu
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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Deshayes S, Godeau B. Second-line and beyond: treatment options for primary persistent and chronic immune thrombocytopenia. Platelets 2019; 31:291-299. [DOI: 10.1080/09537104.2019.1636018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Samuel Deshayes
- Service de Médecine Interne, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l’Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l’Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
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Serra F, Roli I, Campanelli M, Cabry F, Baschieri F, Romano F, Gelmini R. Laparoscopic splenectomy in malignancies: is safe and feasible? MINERVA CHIR 2019; 74:365-373. [PMID: 31062942 DOI: 10.23736/s0026-4733.19.07851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is considered the treatment of choice for benign hematologic diseases of the spleen. However, the role of LS in malignancies is still controversial. Technical difficulties, hemorrhagic risk, the need of pathological characterization of malignant disease, may be considered contraindications to LS in malignancies. This study aims to verify the efficacy and feasibility of LS for hematologic malignancies. METHODS One hundred and forty-five patients underwent LS for hematologic disease and were retrospectively shared in two groups: Group A (N.=83) patients with preoperative diagnosis of benign hematologic disease and Group B (N.=62) with malignancies. Bipolar spleen diameter, mean operative time, conversion rate and causes, complications and need of transfusion were evaluated. RESULTS Median splenic diameter was greater in Group B than in Group A with a statistically significant difference (P<0.005), and the number of accessory mini-laparotomies (P<0.005) and the conversion rate (P=0.024) in the group of patients with a diagnosis of malignancy were also higher. The mean operative time was 117.6 minutes in group A and 148.1 minutes in Group B (P<0.005). Besides, there were no significant differences relative to intraoperative and postoperative transfusions and the incidence of postoperative complications. No perioperative mortality occurred. CONCLUSIONS The analysis of our data highlights that LS for hematologic malignancies is effective and feasible even if it associated with higher conversion rate due to splenomegaly and difficult hilum dissection. Besides, no differences in the patient outcome were highlighted. LS may be considered a safe procedure in the treatment of haematological malignancies of the spleen.
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Affiliation(s)
- Francesco Serra
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Roli
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Campanelli
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Cabry
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Baschieri
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Roberta Gelmini
- Department of Surgery, Polyclinic Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy -
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Huang Y, Wang XY, Wang K. Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A meta-analysis. World J Clin Cases 2019; 7:320-334. [PMID: 30746373 PMCID: PMC6369387 DOI: 10.12998/wjcc.v7.i3.320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hand-assisted laparoscopic splenectomy (HALS) can help overcome the drawbacks of laparoscopic splenectomy (LS) while maintaining its advantages.
AIM To evaluate the efficacy and advantages of HALS for splenomegaly.
METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane, Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from 16 trials who met the inclusion criteria were selected.
RESULTS In pure splenectomy, blood loss volume (P < 0.001) and conversion rate (P = 0.008) were significantly lower in the HALS group than in the LS group. Conversely, for splenomegaly, the operative time (P = 0.04) was shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach (DUS), the operative time (P = 0.04) was significantly shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.
CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.
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Affiliation(s)
- Yong Huang
- Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Yun Wang
- Department of Operating Room, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Kai Wang
- Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Laparoscopic splenectomy: posterolateral approach in patients with liver cirrhosis and portal hypertension with platelet count lower than 1 × 10 9/l. Wideochir Inne Tech Maloinwazyjne 2018; 13:454-459. [PMID: 30524615 PMCID: PMC6280078 DOI: 10.5114/wiitm.2018.77262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/06/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis and portal hypertension in patients with an extremely low platelet count (< 1 × 109/l) presents several challenges. The posterolateral laparoscopic splenectomy approach may be a feasible and safe technique for these patients. Aim To evaluate the feasibility and safety of the posterolateral laparoscopic splenectomy approach in patients with platelet counts < 1 × 109/l secondary to liver cirrhosis and portal hypertension. Material and methods In the period from January 2013 to December 2016, 11 patients with platelet counts < 1 × 109/l secondary to liver cirrhosis and portal hypertension underwent posterolateral laparoscopic splenectomy in our institution. Pre-, peri-, and postoperative medical managements were reviewed retrospectively. Results Patients’ median platelet count was 0.7 × 109/l at the time of inpatient admission. The median operating time was 75 min, and the median intraoperative blood loss was 30 ml. One patient underwent intraoperative transfusion. The median duration of postoperative hospital stay was 5 days. No intra- or postoperative complications ensued, all patients were followed for 12–32 months (median: 24 months), and none had postoperative complications. Conclusions The posterolateral laparoscopic splenectomy approach is a feasible, safe technique in the treatment of patients with platelet counts < 1 × 109/l secondary to liver cirrhosis and portal hypertension.
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Wysocki M, Radkowiak D, Zychowicz A, Rubinkiewicz M, Kulawik J, Major P, Pędziwiatr M, Budzyński A. Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases. J Clin Med 2018; 7:E547. [PMID: 30558132 PMCID: PMC6306709 DOI: 10.3390/jcm7120547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022] Open
Abstract
Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications.
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Affiliation(s)
- Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Dorota Radkowiak
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Anna Zychowicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Jan Kulawik
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
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