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Preukschas AA, Ghadban T, Hackert T, Block A, Nickel F. [Splenic surgery in hematological diseases : Indications and surgical technique]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:987-993. [PMID: 37947801 DOI: 10.1007/s00104-023-01979-7] [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
BACKGROUND Splenic surgery in hematological disorders requires a well-weighted decision on the indications because the medical treatment has rapidly changed in recent years due to new pharmaceutical approaches. OBJECTIVE Summary of the indications, surgical procedures and perioperative management regarding operative interventions on the spleen in hematological disorders. MATERIAL AND METHODS Selective literature search and summary of reviews and guideline recommendations. RESULTS In hematological disorders surgical procedures of the spleen (splenectomy and partial splenectomy) are an important part of the repertoire in the treatment. In recent years the indications for surgery have become narrower because of new forms of medicinal treatment. Especially in hereditary spherocytosis, immune thrombocytopenia and symptomatic splenomegaly and hypersplenism it is still of importance. The minimally invasive splenectomy is regarded as the gold standard. The spleen has an important immune and sequestration function, therefore preoperative and postoperative infectious and thromboembolic events have to be anticipated and prevented. A close interdisciplinary cooperation with hematologists is essential for an optimal outcome of patients. CONCLUSION The minimally invasive splenectomy and partial splenectomy are part of the surgical repertoire in the diagnostics and treatment of hematological disorders. Because of novel medicinal approaches the therapeutic protocols are continuously changing. A close cooperation with hematologists is important for the optimal evaluation of the indications and the perioperative management.
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Affiliation(s)
- Anas Amin Preukschas
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Tarik Ghadban
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Thilo Hackert
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Andreas Block
- II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| | - Felix Nickel
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland.
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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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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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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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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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Quest for the optimal technique of laparoscopic splenectomy - vessels first or hilar transection? Wideochir Inne Tech Maloinwazyjne 2018; 13:460-468. [PMID: 30524616 PMCID: PMC6280088 DOI: 10.5114/wiitm.2018.76071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Throughout our 20 years of experience, we have used several different techniques for laparoscopic splenectomy (LS). However, two methods have been used most frequently: "vessels first" and "hilar transection". Aim To evaluate the outcomes of LS performed with these two different approaches. Material and methods It was an observational study based on retrospective analysis of consecutive patients undergoing LS in a tertiary referral surgical center in the period 1998-2017. We excluded patients with splenic trauma, initially submitted to open surgery, stapled transection of splenic hilum, partial resections of the spleen and other spleen-preserving procedures. Patients were divided into two groups: group 1 ("vessels first") with 188 patients, and group 2 ("hilar transection") with 287 patients. Results Mean operative time was shorter (p < 0.001) and blood loss was lower (p < 0.001) in group 2. The need for blood transfusions and the conversion rate were higher in group 1 (p = 0.044 and p = 0.003 respectively). There was no difference in intraoperative adverse events (p = 0.179). Overall postoperative morbidity did not differ between groups (p = 0.081) and we noted mortality of 0.21% (1 patient of group 2). The morbidity rate associated with accidental injury of the pancreatic parenchyma was significantly higher in group 1 (p = 0.028). Median length of hospital stay was 4 days (range: 1-99) and did not differ between groups (p = 0.175). Conclusions The "vessels first" technique is associated with longer operative time, higher blood loss and increased risk of conversion. "Hilar transection" is associated with lower incidence of local complications related most likely to accidental injury of the pancreatic tail. In the case of a large caliber of splenic vessels the "vessels first" approach remains the technique of choice.
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Shin RD, Lis R, Levergood NR, Brooks DC, Shoji BT, Tavakkoli A. Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear. Surg Endosc 2018; 33:1298-1303. [PMID: 30167946 DOI: 10.1007/s00464-018-6394-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The benefits of laparoscopic splenectomy (LS) over open splenectomy (OS) for normal-sized spleens have been well documented. However, the role of laparoscopy for moderate and massive splenomegaly is debated. METHODS A retrospective review of patients undergoing elective splenectomy at one institution from 1997 to 2017 was conducted. Moderate and massive splenomegaly was defined as splenic weight of 500-1000 g and greater than 1000 g, respectively. We performed a 1:2 matching of laparoscopic to open splenectomy to control for differences in splenic weight. Differences in perioperative morbidity (infection, thromboembolism, reoperation, readmission), intraoperative factors (blood loss, operative time), length of stay, and mortality were examined. RESULTS A total of 491 elective splenectomies were identified. 268 cases were for splenic weights greater than 500 g. After a 1:2 matching of LS:OS, we identified 22 LS and 44 matched OS for moderate splenomegaly. The LS group had longer mean operative times (178 vs. 107 min, p < 0.01), with similar length of stay and blood loss. For massive splenomegaly, 26 LS were identified and matched to 52 OS. LS had longer mean operative times (171 vs. 112 min, p < 0.01) and higher readmission rates (27% vs. 6%, p < 0.05). Other factors and outcomes did not differ between LS and OS for moderate or massive splenomegaly. The conversion rate for LS was higher for massive versus moderate splenomegaly, but was not statistically significant (35% vs. 14%, p = 0.09). CONCLUSIONS LS for moderate and massive splenomegaly is associated with longer operative times. Other perioperative outcomes were comparable to OS, with no demonstrated benefits for LS. Although LS may be a feasible approach to moderate and massive splenomegaly, its benefits require further clarification in this patient population.
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Affiliation(s)
- Reuben D Shin
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Roger Lis
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Nicholas R Levergood
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - David C Brooks
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Brent T Shoji
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Ali Tavakkoli
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Cavaliere D, Solaini L, Di Pietrantonio D, D'Acapito F, Tauceri F, Framarini M, Ercolani G. Robotic vs laparoscopic splenectomy for splenomegaly: A retrospective comparative cohort study. Int J Surg 2018; 55:1-4. [DOI: 10.1016/j.ijsu.2018.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/24/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023]
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Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review. ACTA ACUST UNITED AC 2018; 31:291-302. [PMID: 28438854 DOI: 10.21873/invivo.11058] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Since its introduction in the early 1990s, laparoscopic splenectomy (LS) has gained worldwide acceptance for spleen removal, especially in hematological patients. AIM The present review summarizes the current knowledge and results of LS for the treatment of benign hematological diseases in adults. MATERIALS AND METHODS A MEDLINE/PubMed database research was performed using the terms: "laparoscopic splenectomy" OR "laparoscopy" OR "splenectomy" AND "hematological disorders" OR "hematological disease" OR "hematology" AND "adults" as key words. We set our analysis starting date as January 1st 2010 and the end date as December 31st 2016. We identified 247 relative articles. All the references from the identified articles were searched for relevant information. RESULTS Twenty-seven articles were deemed appropriate for our analysis. LS was found to be feasible and safe in the majority of patients with benign hematological disorders, with a mortality rate ranging from 0% to less than 4% and the postoperative complications rate from 0% to 35.7%. The conversion rate was also very low (4%) and response (complete or partial) was achieved in more than 80% of patients. Lateral approach with four trocars was the most commonly used approach with concommitant cholecystectomy being correlated with increased operative time and morbidity. CONCLUSION Current literature holds that whenever splenectomy is required for the treatment of hematological disorders in adults, a laparoscopic approach should be offered as the gold standard. However, to strengthen the clinical evidence in favor of LS, more high-quality clinical trials on several issues of the procedure are necessary.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, U.S.A.
| | - Nikoletta Dimitriou
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
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Rodriguez-Otero Luppi C, Targarona Soler EM, Balague Ponz C, Pantoja Millán JP, Turrado Rodriguez V, Pallares Segura JL, Bollo Rodriguez J, Trias Folch M. Clinical, Anatomical, and Pathological Grading Score to Predict Technical Difficulty in Laparoscopic Splenectomy for Non-traumatic Diseases. World J Surg 2017; 41:439-448. [PMID: 27541028 DOI: 10.1007/s00268-016-3683-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND We aimed to develop a grading system based on preoperative parameters that would predict surgical difficulty and morbidity in elective laparoscopic splenectomy. STUDY DESIGN We retrospectively assessed morbidity in 439 patients who underwent laparoscopic splenectomy for benign and malignant disorders between 1993 and 2013. Medical and surgical records were reviewed and analyzed. We compared preoperative data concerning demographic, clinical, pathological, anatomical, laboratory, and radiological factors with three surgical outcomes: operative time, intraoperative bleeding, and surgical conversion. Univariate and multivariate analyses were performed to identify statistically significant variables. A logistic regression model was used to identify determinant variables and to compose a predictive score. External validation of the score was performed using an independent cohort of 353 patients. RESULTS Four preoperative parameters (age, male sex, type of pathology, and spleen size based on final spleen weight) were significantly related with operative time, operative bleeding, and conversion to open surgery. Using these results, we developed a classification system with three levels of difficulty: low (≤4 points), medium (4.5-5.5 points), and high (≥6 points), based on the four preoperative parameters. The correlation was highly significant (p = <0.001) according to Spearman's correlation. The area under the ROC curve was 0.671 (95 % CI 0.596-0.745). The external validation showed significant correlations with the present model. CONCLUSIONS The grading score described here is simple to calculate from the physical examination, laboratory tests, and US or CT images, and we believe it could be useful to preoperatively assess the technical complexity of laparoscopic splenectomy.
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Affiliation(s)
- Carlos Rodriguez-Otero Luppi
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| | - Eduardo M Targarona Soler
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Balague Ponz
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Victor Turrado Rodriguez
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jose Luis Pallares Segura
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jesus Bollo Rodriguez
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Manel Trias Folch
- Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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Gonçalves D, Morais M, Costa-Pinho A, Bessa-Melo R, Graça L, Costa-Maia J. Validation of a Difficulty Grading Score in Laparoscopic Splenectomy. J Laparoendosc Adv Surg Tech A 2017; 28:242-247. [PMID: 29019705 DOI: 10.1089/lap.2017.0478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Laparoscopic splenectomy (LS) is the gold standard for the treatment of many spleen-related disorders. However, in the presence of splenomegaly, the rate of conversion to open surgery can be as high as 33.9% and is associated with longer operative times and higher costs. In an attempt to improve risk stratification and patient selection for LS, a score that includes four preoperative parameters (age, gender, diagnosis, and spleen size) has been developed. The aim was the validation of a difficulty grading score, in predicting conversion and poorer outcomes. METHODS Retrospective analysis of 153 consecutive patients subjected to LS from January 2006 through December 2016 was performed. Several parameters were reviewed and correlation with evaluated outcomes was analyzed. RESULTS Conversion to open surgery occurred in 13 (8.50%) patients and was highly associated with serious intraoperative complications. Spearman correlation showed a significant association between the score and risk of conversion, operative time, and postoperative complications, but not with intraoperative bleeding. DISCUSSION Patient and disease features, incorporated in a difficulty grading score, can reliably determine the difficulty of LS and predict risk of conversion, intraoperative, and postoperative complications. This simple and reproducible score improves risk stratification for LS and could be practical in daily clinical activities.
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Affiliation(s)
- Diana Gonçalves
- 1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal .,2 Faculty of Medicine of the University of Porto , Porto, Portugal
| | - Marina Morais
- 1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal .,2 Faculty of Medicine of the University of Porto , Porto, Portugal
| | - André Costa-Pinho
- 1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal .,2 Faculty of Medicine of the University of Porto , Porto, Portugal
| | - Renato Bessa-Melo
- 1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal .,2 Faculty of Medicine of the University of Porto , Porto, Portugal
| | - Luís Graça
- 1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal
| | - J Costa-Maia
- 1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal
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Iolascon A, Andolfo I, Barcellini W, Corcione F, Garçon L, De Franceschi L, Pignata C, Graziadei G, Pospisilova D, Rees DC, de Montalembert M, Rivella S, Gambale A, Russo R, Ribeiro L, Vives-Corrons J, Martinez PA, Kattamis A, Gulbis B, Cappellini MD, Roberts I, Tamary H. Recommendations regarding splenectomy in hereditary hemolytic anemias. Haematologica 2017; 102:1304-1313. [PMID: 28550188 PMCID: PMC5541865 DOI: 10.3324/haematol.2016.161166] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/22/2017] [Indexed: 01/19/2023] Open
Abstract
Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children.
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Affiliation(s)
- Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy .,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Wilma Barcellini
- Oncohematology Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Corcione
- Department of General Surgery, Monaldi Hospital A.O.R.N. dei Colli, Naples, Italy
| | - Loïc Garçon
- Service d'Hématologie Biologique, CHU Amiens Picardie, Amiens, France
| | | | - Claudio Pignata
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Giovanna Graziadei
- Department of Clinical Science and Community Health, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Dagmar Pospisilova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - David C Rees
- Department of Paediatric Haematology, King's College Hospital, King's College London School of Medicine, UK
| | | | - Stefano Rivella
- Department of Pediatrics, Division of Hematology-Oncology, Children's Blood and Cancer Foundation Laboratories, Weill Cornell Medical College, New York, NY, USA; Department of Pediatrics, Division of Hematology, Children's Hospital of Philadelphia, PA, USA
| | - Antonella Gambale
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Roberta Russo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Leticia Ribeiro
- Hematology Service, Hospital and University Center of Coimbra (CHUC), Portugal
| | | | | | | | - Beatrice Gulbis
- Department of Clinical Chemistry, Hôpital Erasme, U.L.B., Brussels, Belgium
| | - Maria Domenica Cappellini
- Department of Clinical Science and Community Health, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Irene Roberts
- Department of Paediatrics, Children's Hospital, University of Oxford, John Radcliffe Hospital, UK
| | - Hannah Tamary
- Pediatric Hematology Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Feng S, Qiu Y, Li X, Yang H, Wang C, Yang J, Liu W, Wang A, Yao X, Lai XH. Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis. Pediatr Surg Int 2016; 32:253-9. [PMID: 26661732 DOI: 10.1007/s00383-015-3845-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children. METHODS Literature searches were conducted to identify studies having compared the laparoscopic splenectomy (LS) and open splenectomy (OS) for children. Parameters such as operative time, blood loss, length of postoperative stay, the removal of accessory spleens and postoperative complications including postoperative high fever, acute chest syndrome (ACS), and ileus were pooled and compared by meta-analysis. RESULTS Among the 922 pediatric participants included in the 10 studies, 508 had received LS and 414 OS. There were shorter length of hospital stays, less blood loss, and longer operative times with the LS approach compared with OS. However, no significant difference was found between LS and OS in the secondary outcome, such as the removal of accessory spleens or postoperative complications including postoperative high fever, ACS, and ileus. CONCLUSION LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss. Besides, total postoperative complications may be slightly lower in LS. We conclude that LS should be considered an acceptable option for children.
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Affiliation(s)
- Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Yuhui Qiu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Xiang Li
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Huajun Yang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Chen Wang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Junjia Yang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Weiguang Liu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Aihe Wang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China
| | - Xianming Yao
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China.
| | - Xin-He Lai
- Institute of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Laparoscopic splenectomy is a better surgical approach for spleen-relevant disorders: a comprehensive meta-analysis based on 15-year literatures. Surg Endosc 2016; 30:4575-88. [DOI: 10.1007/s00464-016-4795-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/27/2016] [Indexed: 12/14/2022]
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Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children. Gastroenterol Res Pract 2015; 2015:603915. [PMID: 26491432 PMCID: PMC4600895 DOI: 10.1155/2015/603915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/17/2014] [Indexed: 12/19/2022] Open
Abstract
Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens. Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). The patients are divided into two groups according to spleen's longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay. Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P > 0.05). Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens.
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Zhou J, Wu Z, Zhou Z, Wang Z, Liu Y, Huang XY, Peng B. Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus. Clin Rheumatol 2013; 32:1131-8. [PMID: 23549638 DOI: 10.1007/s10067-013-2230-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/11/2013] [Accepted: 02/27/2013] [Indexed: 02/05/2023]
Abstract
This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 10(9)/L before splenectomy to 289.2 × 10(9)/L and 144.2 × 10(9)/L after 3 and 6 months, respectively, and was 115.5 × 10(9)/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.
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Affiliation(s)
- Jin Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Abstract
BACKGROUND Some areas of laparoscopic splenectomy (LS), such as the approach to splenic pedicle dissection, remain controversial. Here we recommend a technique for dissecting the secondary splenic pedicle vessels on the basis of analysis of retrospective data. STUDY DESIGN A retrospective review (April 2006 to October 2011) of databases at 2 institutions identified 136 patients who had undergone LS. In 34 patients with massive splenomegaly, primary splenic pedicle dissection technique (PSPD) had been used in 19 patients and secondary splenic pedicle dissection technique (SSPD) had been used in 15 patients. In 102 patients with normal-sized spleen or moderate splenomegaly, PSPD had been used in 56 patients and SSPD in 46 patients. We compared perioperative and follow-up data. RESULTS Laparoscopic splenectomy was completed in 128 patients. In the massive splenomegaly group, the conversion rate was 5.3% for PSPD and 33.3% for SSPD, the complication rate was 42.1% vs 20%, hospital stay was 3.2 ± 2.0 days vs 7.5 ± 3.5 days, and transfusion requirement was 1.1 ± 1.2 U vs 3.2 ± 0.9 U, respectively. However, in the normal or moderate splenomegaly group, except for complications, there were no significant differences between PSPD and SSPD techniques in perioperative findings. In the 2 groups, there were significant differences between the PSPD and SSPD techniques in pancreatic leakage (15.8% vs 0 and 8.9% vs 0, respectively) and postoperative fever (15.8% vs 6.7% and 10.7% vs 2.2%, respectively). CONCLUSIONS Secondary splenic pedicle dissection can decrease the incidence of splenic fever and pancreatic leakage and is a valuable technique for LS for normal-sized spleen or moderate splenomegaly. It is not a safe procedure for massive splenomegaly because of the high conversion rate.
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