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Kashiwagi R, Ishida M, Onodera K, Aoki S, Iseki M, Miura T, Ohtsuka H, Mizuma M, Nakagawa K, Kamei T, Unno M. Laparoscopic excision of accessory spleen for recurrent autoimmune hemolytic anemia after splenectomy: a case report. Surg Case Rep 2024; 10:110. [PMID: 38700738 PMCID: PMC11068696 DOI: 10.1186/s40792-024-01884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Splenectomy is indicated in cases of autoimmune hemolytic anemia (AIHA), which are refractory to medical management. In post-splenectomy, there exists a theoretical risk of AIHA recurrence, especially if an accessory spleen undergoes compensatory hypertrophy. In this context, we present a unique case of recurrent AIHA managed through laparoscopic excision of the accessory spleen (LEAS). CASE PRESENTATION A 60-year-old male underwent laparoscopic splenectomy (LS) for AIHA refractory to standard medical therapies. Following the surgery, there was a marked improvement in hemolytic anemia symptoms, and oral steroid therapy was terminated 7 months post-LS. Nonetheless, a year after the LS, the patient exhibited a marked decline in hemoglobin levels, dropping to a concerning 5.8 g/dl, necessitating the reintroduction of oral steroids. A subsequent contrast-enhanced computed tomography (CT) scan unveiled an enlarged accessory spleen. The patient then underwent LEAS, during which the accessory spleen, obscured within adipose tissue, proved challenging to visualize laparoscopically. This obstacle was surmounted utilizing intraoperative ultrasonography (US), enabling successful excision of the accessory spleen. The post-surgical period progressed without complications, and the steroid dosage was reduced to one-twelfth of its initial preoperative quantity. CONCLUSIONS Recurrent AIHA can be instigated by post-splenectomy compensatory hypertrophy of the accessory spleen. Ensuring comprehensive splenic tissue excision is crucial in AIHA management to obviate recurrent stemming from hypertrophic remnants. In scenarios of AIHA recurrence tied to an enlarged accessory spleen, LEAS stands as a viable and effective therapeutic modality.
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Affiliation(s)
- Ryosuke Kashiwagi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Koichi Onodera
- Department of Hematology, Tohoku University Hospital, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan.
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Caye A, Lemons S, Mathias L, Collins Z, Miller K, Rohr A. Percutaneous Splenule Ablation for Recurrent Idiopathic Thrombocytopenia Following Splenectomy- A Case Series. J Vasc Interv Radiol 2021; 33:352-354. [PMID: 34922015 DOI: 10.1016/j.jvir.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Adrien Caye
- M.D. Candidate, Class of 2024, University of Kansas Medical Center, Department of Radiology, 3901 Rainbow Boulevard, Mail Stop 4032, Kansas City, Kansas 66160.
| | - Steven Lemons
- University of Kansas Medical Center, Department of Radiology
| | - Larry Mathias
- University of Kansas Medical Center, Department of Radiology
| | - Zachary Collins
- University of Kansas Medical Center, Department of Radiology
| | - Kirk Miller
- University of Kansas Medical Center, Department of Radiology
| | - Aaron Rohr
- University of Kansas Medical Center, Department of Radiology
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Kindel TL, Dirks RC, Collings AT, Scholz S, Abou-Setta AM, Alli VV, Ansari MT, Awad Z, Broucek J, Campbell A, Cripps MW, Hollands C, Lim R, Quinteros F, Ritchey K, Whiteside J, Zagol B, Pryor AD, Walsh D, Haggerty S, Stefanidis D. Guidelines for the performance of minimally invasive splenectomy. Surg Endosc 2021; 35:5877-5888. [PMID: 34580773 DOI: 10.1007/s00464-021-08741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear. OBJECTIVE To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations. RESULTS Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions. CONCLUSIONS Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.
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Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Stefan Scholz
- Department of Surgery, Division of Pediatric Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Vamsi V Alli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Joseph Broucek
- Department of Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Andre Campbell
- Department of Surgery, University of California, San Francisco, San Francisco, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Robert Lim
- Department of Surgery, University of Oklahoma School of Medicine Tulsa, Tulsa, USA
| | | | - Kim Ritchey
- Division of Pediatric Hematology and Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Jake Whiteside
- Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Zagol
- Charles George Veterans Affairs Medical Center, Asheville, USA
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | - Danielle Walsh
- Department of Surgery, East Carolina University, Greenville, USA
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
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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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Schmidt SC, Möller J, Bürgel N, Radke C, Beyer L, Marusch F. Minimally invasive accessory splenectomy for recurrent gastric variceal bleeding due to left-sided portal hypertension: report of the first case. J Surg Case Rep 2021; 2021:rjab008. [PMID: 33604020 PMCID: PMC7877905 DOI: 10.1093/jscr/rjab008] [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: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Upper gastrointestinal bleeding from esophagogastric varices is a common scenario, especially in patients with portal hypertension induced by liver cirrhosis or other diseases with thrombosis of the splenic vein. However, accessory spleen as pathophysiological cause of a regional, left-sided portal hypertension and consecutive development of isolated gastric varices is rare. We report a case of recurrent gastric variceal bleeding resulting from sinistral portal hypertension associated with an accessory spleen in a patient who had traumatic splenectomy many decades before. The accessory spleen is an extremely rare cause for the development of regional, left-sided portal hypertension leading to isolated gastric varices. Minimally invasive splenectomy is a safe and efficient treatment option.
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Affiliation(s)
- S C Schmidt
- Department for Hepato-Pancreato-Biliary Surgery, Ernst von Bergmann Clinic, Potsdam, Germany
| | - J Möller
- Department for Hepato-Pancreato-Biliary Surgery, Ernst von Bergmann Clinic, Potsdam, Germany
| | - N Bürgel
- Department for Gastroenterology and Infectiology, Ernst von Bergmann Clinic, Potsdam, Germany
| | - C Radke
- Institute for Pathology, Ernst von Bergmann Clinic, Potsdam, Germany
| | - L Beyer
- Department for Radiology, Ernst von Bergmann Clinic, Potsdam, Germany
| | - F Marusch
- Clinic for General-, Visceral-, Vascular- and Thoracic Surgery, Ernst von Bergmann Clinic, Potsdam, Germany
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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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Laparoscopic Resection of a Left Upper Quadrant Mass Leading to a Surprise Diagnosis. Case Rep Surg 2020; 2020:8365061. [PMID: 32566350 PMCID: PMC7284930 DOI: 10.1155/2020/8365061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background. Resplenectomy is most commonly done for the treatment of recurrent idiopathic thrombocytopenic purpura (ITP) refractory to medical management due to the regrowth of a missed accessory spleen. Case Report. A 66-year-old male had undergone open splenectomy for traumatic rupture 40 years ago. He presented with a leiomyosarcoma of his leg, which was surgically removed. When he developed metastatic disease, chemotherapy was started. He developed left upper quadrant pain, and on CT scan, a 5 cm mass compatible with a sarcoma was found between the tail of the pancreas and the left adrenal gland. During laparoscopy, dense adhesion of the omentum to the abdominal wall and the stomach from his previous splenectomy was divided. The lesser sac was opened through the gastrocolic ligament, and the splenic flexure was taken down. Superior and dorsal to the tail of the pancreas next to the left adrenal gland, the mass was identified and carefully dissected out. The vascular pedicle, which originated from a side branch of the splenic vessels at the tail of the pancreas, was stapled. The gastric fundus showed multiple nodules, and therefore, a modified sleeve gastrectomy was done; also, a 2 cm nodule in segment 5 of the liver and an omental nodule were removed. The tumors and gastrectomy specimen were placed in an endobag and removed through a periumbilical mini-incision. The patient recovered without any complications from the procedure and his LUQ pain resolved. Pathology revealed no sarcoma metastases but accessory spleens in all specimens. Discussion. Splenosis with multiple implants within the abdomen after splenectomy for trauma is a rare condition. In our patient, this seems to have been triggered by chemotherapy for his sarcoma resulting in extramedullary hemopoiesis. Laparoscopic removal of accessory spleens can be safely done.
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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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Abstract
INTRODUCTION Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients. METHODS Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy. The distinction between open (OS) and laparoscopic splenectomy (LS) was analyzed. Primary outcome was composite: hospitalization for bleeding and/or thrombocytopenia and death from hemorrhage or infection. Secondary outcomes were based on response (R) and complete response (CR) rates as defined by the American Society of Hematology. RESULTS Ninety-six patients were included: 30 patients received Rituximab, 37 underwent OS, and 29 underwent LS. The follow-up was 30, 60, and 120 months in Rituximab, LS, and OS groups, respectively. At 30 month, the primary outcome-free survival rate was higher in splenectomy groups (84% for OS, 86% for LS) than Rituximab group (47%) (P = 0.0002). Similarly, at 30 month, R and CR rates were higher for OS (86.5% and 75.7%, respectively) and LS groups (93.1% and 89.7%) than Rituximab (46.7% and 30%) (P = 0.0001). Moreover, R rates remained elevated at 60 month for OS and LS groups (83.7% and 89.6% respectively) and 78.4% at 120 month for OS group. CONCLUSION We observed that splenectomy for ITP second-line treatment was more effective than Rituximab regarding maintenance of R, CR, and overall response rates. OS and LS had similar efficacy.
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10
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Laparoscopic removal of an accessory spleen for recurrent idiopathic thrombocytopenic purpura 5 years after laparoscopic splenectomy using perioperative eltrombopag conditioning. Eur Surg 2017. [DOI: 10.1007/s10353-016-0461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vaos G, Mantadakis E, Gardikis S, Pitiakoudis M. The role of laparoscopy in the identification and management of missing accessory spleens after primary splenectomy: A case report and literature review. J Indian Assoc Pediatr Surg 2016; 21:196-198. [PMID: 27695216 PMCID: PMC4980885 DOI: 10.4103/0971-9261.186554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We present a 7-year-old boy with recurrent thrombocytopenia after primary laparoscopic splenectomy for immune thrombocytopenia (ITP). Imaging modalities (ultrasound, computed tomography scan, and scintigraphy) revealed two accessory spleens while the subsequent second laparoscopy revealed 11, which were successfully removed. The relevant medical literature is reviewed, and the value of laparoscopy for chronic ITP is highlighted.
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Affiliation(s)
- George Vaos
- Department of Pediatric Surgery, Alexandroupolis University General Hospital, Faculty of Medicine, Democritus University of Thrace, Thrace, Greece
| | - Elpis Mantadakis
- Department of Pediatrics, Alexandroupolis University General Hospital, Faculty of Medicine, Democritus University of Thrace, Thrace, Greece
| | - Stefanos Gardikis
- Department of Pediatric Surgery, Alexandroupolis University General Hospital, Faculty of Medicine, Democritus University of Thrace, Thrace, Greece
| | - Michael Pitiakoudis
- Second Department of Surgery, Alexandroupolis University General Hospital, Faculty of Medicine, Democritus University of Thrace, Thrace, Greece
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13
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Long-term outcomes after pediatric splenectomy. Surgery 2016; 159:1583-1590. [PMID: 26832988 DOI: 10.1016/j.surg.2015.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Splenectomy is performed frequently for various and primarily hematologic indications in children and adolescents. We analyzed the long-term outcome after splenectomy (median, 8.7 years) focusing on sepsis, portal vein thrombosis (PVT), and retained accessory spleen. METHODS In total, 141 consecutive children after open (n = 89; 63%) or laparoscopic (n = 52; 37%) splenectomy from 1991 to 2010 were followed up through nationwide registries for septic infections, PVT, and causes of death. Sixty-six patients (58% of survivors) answered a structured questionnaire on infections, abdominal symptoms, and general health, and 64 (laparoscopic n = 26, open n = 38) consented to ultrasonography of the portal venous system. RESULTS Median operation age was 8.8 years (range, 1.0-22). Reoperations were required for bleeding after open procedures (n = 1) and retained accessory spleen after laparoscopic procedures (n = 3). Postsplenectomy sepsis occurred after a median of 1.7 years (range, 0.2-5.9) in 11 patients (8%), of whom 10 had an underlying immunodeficiency. No cases of PVT were observed, although the median portal vein flow was 1,130 mL/min (range, 440-2200) and diameter was 9.9 mm (range, 7-15) at a median follow-up of 9.5 years (range, 2.0-22) after splenectomy. Twenty-seven patients (19%) died after 8.7 years (0.03-23.00). The most common cause of death was the underlying malignancy (n = 15), with sepsis being an additional cause of death in 5 patients. CONCLUSION Postsplenectomy sepsis was associated almost exclusively with an underlying immunodeficiency with a high mortality rate. No PVT was observed. The overall risk of retained accessory spleen was around 7%, and was slightly greater after laparoscopic operation.
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Yeung TM, Volpi D, Tullis IDC, Nicholson GA, Buchs N, Cunningham C, Guy R, Lindsey I, George B, Jones O, Wang LM, Hompes R, Vojnovic B, Hamdy F, Mortensen NJ. Identifying Ureters In Situ Under Fluorescence During Laparoscopic and Open Colorectal Surgery. Ann Surg 2016; 263:e1-2. [PMID: 26672509 DOI: 10.1097/sla.0000000000001513] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Trevor M Yeung
- *Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK †Department of Colorectal Surgery, Churchill Hospital, Oxford, UK ‡Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Oxford, UK §Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
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LEO C, PRAVISANI R, BIDINOST S, BACCARANI U, BRESADOLA V, RISALITI A, TERROSU G. Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen. G Chir 2015; 36:153-7. [PMID: 26712069 PMCID: PMC4732584 DOI: 10.11138/gchir/2015.36.4.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice. PATIENTS AND METHODS At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen. RESULTS The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy. CONCLUSIONS The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.
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Affiliation(s)
- C.A. LEO
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - R. PRAVISANI
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - S. BIDINOST
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - U. BACCARANI
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - V. BRESADOLA
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - A. RISALITI
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - G. TERROSU
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
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Casaccia M, Stabilini C, Gianetta E, Ibatici A, Santori G. Current concepts of laparoscopic splenectomy in elective patients. World J Surg Proced 2014; 4:33-47. [DOI: 10.5412/wjsp.v4.i2.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/13/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Formerly, open splenectomy represented the conventional surgical treatment for many hematologic diseases. Currently, thanks to permanent technical development and improved skills, also laparoscopic splenectomy (LS) has become a recognized procedure in the treatment of spleen diseases, even in case of splenomegaly. A systematic review was performed with the aim of recalling the proved concepts of this surgical treatment and to browse new devices and techniques and their impact on the surgical outcome. The literature search was initially conducted in PubMed by entering general queries related to LS. The record identified through PubMed searching (n = 1599) was then screened by applying several criteria (study published in English from 1991 to 2013 with abstract available, by excluding systematic/non-systematic reviews, meta-analysis, practice guidelines, case reports, and study involving animals). The articles assessed for eligibility (n = 160) were primarily evaluated by excluding studies that did not report operative time and conversion to open surgery. For articles that treated multiport LS we included only clinical trials with patients > 20. The studies included in qualitative synthesis were 23. The search strategy carried out in PubMed does not allow to obtain an overview of the items returned by the main queries. With this aim we replicated the search in the Web of ScienceTM database, only including the studies published in English in the period 1991-2013 with no other filter/selection criteria. The full records (n = 1141) and cited references returned by Web of ScienceTM were analyzed with the visualization of similarities (VOS) mapping technique. Maps of title/abstract text corpus and bibliographic coupling of authors obtained by applying the VOS approach were presented. If in normal-size or moderately enlarged spleens the laparoscopic approach is unquestionable, in massive splenomegaly the optimal technique remain to be determined. In this setting, prospective randomized trials to compare open vs LS are needed. Between the new techniques of LS the robotic single port splenectomy has the ability to join all the positive aspects of both techniques. Data about this topic are too initial and need to be confirmed with further studies.
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Gamme G, Birch DW, Karmali S. Minimally invasive splenectomy: an update and review. Can J Surg 2013; 56:280-5. [PMID: 23883500 PMCID: PMC3728249 DOI: 10.1503/cjs.014312] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 12/14/2022] Open
Abstract
Laparoscopic splenectomy (LS) has become an established standard of care in the management of surgical diseases of the spleen. The present article is an update and review of current procedures and controversies regarding minimally invasive splenectomy. We review the indications and contraindications for LS as well as preoperative considerations. An individual assessment of the procedures and outcomes of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, natural orifice transluminal endoscopic splenectomy and single-port splenectomy is included. Furthermore, this review examines postoperative considerations after LS, including the postoperative course of uncomplicated patients, postoperative portal vein thrombosis, infections and malignancy.
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Affiliation(s)
- Gary Gamme
- Faculty of Medicine, University of Calgary, Calgary
| | - Daniel W. Birch
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
| | - Shahzeer Karmali
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
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Golash V. The Role of Pre-emptive Control of Vascular Pedicle in Laparoscopic Splenectomy: An Experience with 19 Consecutive Patients. Oman Med J 2011; 26:136-40. [PMID: 22043402 DOI: 10.5001/omj.2011.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/25/2010] [Indexed: 11/03/2022] Open
Affiliation(s)
- Vishwanath Golash
- Department of General Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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Abstract
Laparoscopic splenectomy was first reported in 1991-1992 by several groups. The impact and role of laparoscopy for splenectomy can be considered as significant as that for gallbladder disease, achalasia, esophageal reflux, and adrenal disease. In many centers, the laparoscopic approach is now routine for most cases of elective splenectomy. The laparoscopic approach is associated with reduced morbidity, especially pulmonary, wound, and infectious complications. This article reviews a standardized approach to laparoscopic and hand-assisted splenectomy and covers indications, operative strategy, and complications. Several special considerations, including massive splenomegaly, postsplenectomy thrombosis of the portosplenic venous system, and accessory spleens are also discussed.
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Affiliation(s)
- Liane S Feldman
- Section of Minimally Invasive Surgery, Division of General Surgery, McGill University Health Centre, 1650 Cedar Avenue, L9-412, Montreal, QC, H3G 1A4, Canada.
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Bognár G, István G, Ledniczky G, Barabás L, Ondrejka P. [Analysis of two different operative techniques for laparoscopic splenectomy]. Magy Seb 2010; 63:359-363. [PMID: 21147668 DOI: 10.1556/maseb.63.2010.6.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Laparosocopic splenectomy gradually became the gold standard procedure in the surgical treatment of certain haematological disorders. Operative experience in laparoscopic procedures facilitates the comparison of various techniques. AIM Two variants in laparoscopic spelenectomy are analysed and presented. MATERIAL AND METHOD Sixteen patients underwent laparoscopic spelenectomy. Anterior- and postero-anterior laparoscopic approaches are compared with respect to clinicopathologic features. CONCLUSIONS Using the postero-anterior technique dissection of splenic hilum is more straightforward, recognition of accessory spleen is easier and the likelihood of intraoperative complications is less. In selected cases of splenomegaly the anterior technique is recommended though.
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Affiliation(s)
- Gábor Bognár
- Semmelweis Egyetem II. sz. Sebészeti Klinika 1125 Budapest Kútvölgyi út 4.
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