Techniques of laparoscopic morcellation of the spleen

Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases

BACKGROUND

Laparoscopic splenectomy has become the standard of care for benign hematological disease affecting the spleen; its role in massive splenomegaly remains controversial. In this study, we evaluated the outcome of laparoscopic splenectomies in terms of spleen size in a group of 83 patients of benign hematological diseases.

METHODS

From July 2003 to December 2009, 83 patients underwent laparoscopic splenectomy for various benign hematological diseases. The data were recorded and analyzed in a retrospective manner. The patients were divided in to two groups according to the spleen weight; group I < 2,000 g (n = 54) and group II > 2,000 g (n = 29). Age, sex, hematological condition, operative time, estimated blood loss, conversion to open surgery, splenic weight, length of hospital stay, time to liquid diet, and morbidity were all recorded.

RESULTS

Laparoscopic splenectomy was completed in 79 patients (95.2 %). Operative time (p = 0.01) and estimated blood loss (p = 0.001) was more in group II. The length of hospital stay (p = 0.05) and the postoperative morbidity (p = 0.001) also were significantly more in the second group. There was no mortality.

CONCLUSIONS

Laparoscopic splenectomy is possible and safe for massive splenomegaly in hematological disease (>2,000 g), but it needs longer operative time and hospital stay.

Splenomegaly should not be considered a contraindication for laparoscopic splenectomy

OBJECTIVE

To analyze the impact of spleen size on operative and immediate clinical outcome in a series of 74 laparoscopic splenectomies (LS).

SUMMARY BACKGROUND DATA

LS is gaining acceptance as an alternative to open splenectomy. However, splenomegaly hinders LS, and massive splenomegaly has been considered a contraindication.

METHODS

Between February 1993 and September 1997, 74 patients with a wide range of splenic disorders were treated by laparoscopy and prospectively recorded. They were classified into three groups according to spleen weight: group I, <400 g (n = 52); group II, 400 to 1000 g (n = 9); and group III, >1000 g (n = 13). Age, operative time, number of trocars required, need for perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia requirements, length of hospital stay, and morbidity rates were recorded.

RESULTS

LS was completed in 69 patients, and the conversion rate was thus 6.7%. Operative time was significantly longer in patients with larger spleens, and an accessory incision was more frequently required. However, there were no significant differences in transfusion rate, length of stay, severe morbidity, or conversion rate.

CONCLUSIONS

Preliminary evaluation of LS for patients with large spleens suggests that it requires a longer operative time, but it is feasible and may potentially offer the same advantages (shorter stay and faster recovery) as it does to those with smaller spleens.

Clostridial gas gangrene of the abdominal wall after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy.