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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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2
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Hu Y, Zhou W, Sun S, Guan Y, Ma J, Xie Y. 18F-fluorodeoxyglucose positron emission tomography-based prediction for splenectomy in patients with suspected splenic lymphoma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1009. [PMID: 34277809 PMCID: PMC8267279 DOI: 10.21037/atm-21-2790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/17/2021] [Indexed: 12/11/2022]
Abstract
Background Diagnostic splenectomy is often performed on patients with suspected splenic lymphoma. However, unnecessary splenectomy entails more harm than benefit for patients. Therefore, a preliminary screening method for patients with suspected splenic lymphoma that has high sensitivity and specificity is urgently needed. Methods From the pathology database at Huadong and Huashan Hospital, we retrospectively identified 60 patients of suspected splenic lymphoma who underwent fluorodeoxyglucose (FDG)-positron emission tomography (PET) before receiving a splenectomy and did not show any increase in FDG uptake except in the spleen. We compared the indicators of PET-CT, such as the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and the SUVmax of 18F-FDG uptake ratios between the spleen/liver, spleen/bone marrow, and liver/bone marrow. Results No significant differences were detected in SUVmax, TLG, MTV, or the SUVmax ratio of the liver/bone marrow between the lymphoma and benign groups. However, the SUVmax ratios of the spleen/liver and spleen/bone marrow were significantly higher in the lymphoma group than in the benign group (P=0.001; P=0.001). Receiver operating characteristic (ROC) curve analysis determined a spleen/liver SUVmax ratio of >2.42 and a spleen/bone marrow SUVmax ratio of >1.45 to be the indications for requiring a diagnostic splenectomy for lymphoma. Parallel testing increased the specificity and sensitivity of the test. Conclusions Patients whose PET-CT results are inconclusive regarding the need for splenectomy may benefit from our prediction model. Future large-scale prospective clinical trials are required to verify these findings.
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Affiliation(s)
- Yingwei Hu
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China
| | - Weiyan Zhou
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Siyuan Sun
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Integrative Medicine, Fudan University, Shanghai, China
| | - Jiexian Ma
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yanhui Xie
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China
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3
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Lazaar H, Malki Y, Bouhout T, Serji B, El Harroudi T. Partial Splenectomy for a Sizeable Cavernous Hemangioma: Case Report and a Review of the Literature. Cureus 2021; 13:e12882. [PMID: 33633911 PMCID: PMC7899278 DOI: 10.7759/cureus.12882] [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: 11/05/2022] Open
Abstract
The recent awareness of the spleen's important role, especially its immune function, has fundamentally changed the management of splenic diseases, promoting the splenic preserving surgery, and protecting from the significant risk of total splenectomy: overwhelming post-splenectomy sepsis. Partial splenectomy is a safe and feasible technique that offers, according to the literature, the same results of a total approach, either in achieving hematological benefits in congenital hemolytic anemia, or treating the focal splenic lesion such as hemangioma, while preserving the immune function.
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Affiliation(s)
- Hatim Lazaar
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Yosra Malki
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tariq Bouhout
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
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4
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Rothman JA, Stevens JL, Gray FL, Kalfa TA. How I approach hereditary hemolytic anemia and splenectomy. Pediatr Blood Cancer 2020; 67:e28337. [PMID: 32391969 DOI: 10.1002/pbc.28337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/19/2023]
Abstract
Hereditary hemolytic anemias (HHA) are a heterogeneous group of anemias associated with decreased red cell survival. While there can be clinical benefit of splenectomy in many cases, splenectomy is not appropriate for all types of HHA. Additionally, there are significant risks during and following splenectomy including surgical risks, postsplenectomy sepsis, and thrombotic complications. This review discusses the diagnostic approach to HHA as well as the role of splenectomy in the management. Surgical approaches and outcomes for total and partial splenectomy are discussed.
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Affiliation(s)
- Jennifer A Rothman
- Division of Pediatric Hematology/Oncology, Duke University, Durham, North Carolina
| | - Jenny L Stevens
- Division of Pediatric Surgery, Children's Hospital of New Orleans, New Orleans, Louisiana.,Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Fabienne L Gray
- Division of Pediatric Surgery, Children's Hospital of New Orleans, New Orleans, Louisiana.,Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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5
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Milosavljević VM, Tadić BS, Grubor NM, Eric DV, Matić SV. Laparoscopic splenectomy in the treatment of the splenic pseudotumor and preservation accessory spleen. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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Costi R, Castro Ruiz C, Romboli A, Wind P, Violi V, Zarzavadjian Le Bian A. Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases. J Pediatr Surg 2019; 54:1527-1538. [PMID: 30665627 DOI: 10.1016/j.jpedsurg.2018.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. METHODS A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. RESULTS Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. CONCLUSIONS Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia.
| | | | - Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Philippe Wind
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France
| | - Vincenzo Violi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris "Descartes", Paris, France
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7
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Esposito F, Noviello A, Moles N, Cantore N, Baiamonte M, Coppola Bottazzi E, Miro A, Crafa F. Partial splenectomy: A case series and systematic review of the literature. Ann Hepatobiliary Pancreat Surg 2018; 22:116-127. [PMID: 29896572 PMCID: PMC5981141 DOI: 10.14701/ahbps.2018.22.2.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023] Open
Abstract
Backgrounds/Aims Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. Methods Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. Results Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5–50%) and in 3% of cases (range, 7–10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5–25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). Conclusions The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.
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Affiliation(s)
- Francesco Esposito
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Adele Noviello
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Nicola Moles
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Nicola Cantore
- Department of Hematology and Stem Cell Transplantation, S.G. Moscati Hospital, Avellino, Italy
| | - Mario Baiamonte
- Department of General and Emergency Surgery, Civico Hospital, Palermo, Italy
| | | | - Antonio Miro
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Francesco Crafa
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
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8
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Wang L, Xu J, Li F, Zhan H, Liu H, Chen W, Hu S. Partial Splenectomy is Superior to Total Splenectomy for Selected Patients with Hemangiomas or Cysts. World J Surg 2017; 41:1281-1286. [PMID: 28058472 DOI: 10.1007/s00268-016-3794-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superiority of partial splenectomy (PS) as a treatment for benign tumors has not well been confirmed. This study aimed to identify the short- and long-term outcomes of PS, to compare laparoscopic and laparotomic PS, and to demonstrate whether the effects of PS are superior to that of total splenectomy (TS). METHODS Patients with either a hemangioma or cyst who underwent PS or TS from 2009 to 2015 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed. RESULTS A total of 17 patients underwent PS were collected, including 2 men and 15 women with a mean age of 43.9 ± 11.3 years old. Patients who underwent laparoscopic PS (9 cases) had a longer operative time and shorter postoperative hospital stay than those who underwent laparotomy (8 cases). Compared with TS (22 cases), PS significantly decreased the incidence of thrombocytosis, shortened time until drainage removal, and shortened postoperative hospital stay. After an average follow-up of 34.8 months, patients who underwent TS showed a higher incidence of thrombocytosis and splenic vein thrombosis compared with patients underwent PS. CONCLUSIONS PS is technically feasible and provides favorable short- and long-term outcomes for selected patients with either a hemangioma or cyst compared with TS. Laparoscopic PS shows lower morbidity and equal therapeutic efficacy compared with laparotomic PS and can be widely performed.
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Affiliation(s)
- Lei Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Jianwei Xu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Feng Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Hanxiang Zhan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Han Liu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Wei Chen
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.
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9
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Giudice V, Rosamilio R, Serio B, Di Crescenzo RM, Rossi F, De Paulis A, Pilone V, Selleri C. Role of Laparoscopic Splenectomy in Elderly Immune Thrombocytopenia. Open Med (Wars) 2017; 11:361-368. [PMID: 28352821 PMCID: PMC5329853 DOI: 10.1515/med-2016-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/19/2016] [Indexed: 12/17/2022] Open
Abstract
The management of older patients with chronic primary immune thrombocytopenia (ITP) is still very challenging because of the fragility of older patients who frequently have severe comorbidities and/or disabilities. Corticosteroid-based first-line therapies fail in most of the cases and patients require a second-line treatment, choosing between rituximab, thrombopoietin-receptor agonists and splenectomy. The choice of the best treatment in elderly patients is a compromise between effectiveness and safety and laparoscopic splenectomy may be a good option with a complete remission rate of 67% at 60 months. But relapse and complication rates remain higher than in younger splenectomized ITP patients because elderly patients undergo splenectomy with unfavorable conditions (age >60 year-old, presence of comorbidities, or multiple previous treatments) which negatively influence the outcome, regardless the hematological response. For these reasons, a good management of concomitant diseases and the option to not use the splenectomy as the last possible treatment could improve the outcome of old splenectomized patients.
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Affiliation(s)
- Valentina Giudice
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Rosa Rosamilio
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Bianca Serio
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | | | - Francesca Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pilone
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
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10
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Eker T, Kocaay AF, Sevim Y, Çakmak A. Splenic hamartoma is a rare cause of abdominal pain: Case report and literature review. Turk J Surg 2015; 33:294-295. [PMID: 29260137 DOI: 10.5152/ucd.2015.3048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/21/2015] [Indexed: 12/21/2022]
Abstract
Hamartoma is a rare benign tumor of the spleen. It is often asymptomatic and diagnosed incidentally. In this study, we report the case of a 51-year-old female patient who was admitted to our department for intermittent epigastric pain since the last 6 months and left upper quadrant fullness. She was diagnosed with splenic hamartoma histopathologically after splenectomy. Although splenic hamartoma is very rare, it must be included in the differential diagnosis of splenic mass-forming lesions.
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Affiliation(s)
- Tevfik Eker
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Akın Fırat Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Yusuf Sevim
- Clinic of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Atıl Çakmak
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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11
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Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences. Surg Endosc 2015; 29:3618-27. [PMID: 25740639 DOI: 10.1007/s00464-015-4118-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/13/2015] [Indexed: 12/13/2022]
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12
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Bickenbach KA, Gonen M, Labow DM, Strong V, Heaney ML, Zelenetz AD, Coit DG. Indications for and efficacy of splenectomy for haematological disorders. Br J Surg 2013; 100:794-800. [PMID: 23436638 DOI: 10.1002/bjs.9067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Splenectomy is performed for a variety of indications in haematological disorders. This study was undertaken to analyse outcomes, and morbidity and mortality rates associated with this procedure. METHODS Patients undergoing splenectomy for the treatment or diagnosis of haematological disease were included. Indications for operation, preoperative risk, intraoperative variables and short-term outcomes were evaluated. RESULTS From January 1997 to December 2010, 381 patients underwent splenectomy for diagnosis or treatment of haematological disease. Some 288 operations were performed by an open approach, 83 laparoscopically, and there were ten conversions. Overall 136 patients (35·7 per cent) experienced complications. Postoperative morbidity was predicted by age more than 65 years (odds ratio (OR) 1·63, 95 per cent confidence interval 1·05 to 2·55), a Karnofsky performance status (KPS) score lower than 60 (OR 2·74, 1·35 to 5·57) and a haemoglobin level of 9 g/dl or less (OR 1·74, 1·09 to 2·77). Twenty-four patients (6·3 per cent) died within 30 days of surgery. Postoperative mortality was predicted by a KPS score lower than 60 (OR 16·20, 6·10 to 42·92) and a platelet count of 50,000/µl or less (OR 3·34, 1·25 to 8·86). The objective of the operation was achieved in 309 patients (81·1 per cent). The success rate varied for each indication: diagnosis (106 of 110 patients, 96·4 per cent), thrombocytopenia (76 of 115, 66·1 per cent), anaemia (10 of 16, 63 per cent), to allow further treatment (46 of 59, 78 per cent) and primary treatment (16 of 18, 89 per cent). CONCLUSION Splenectomy is an effective procedure in the diagnosis and treatment of haematological disease in selected patients.
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Affiliation(s)
- K A Bickenbach
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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13
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Uranues S. J.O. Larkin, P.A. Carroll, P.H. McCormick, B.J. Mehigan: Control of splenic bleeding during splenic flexure mobilisation by devascularisation of the inferior pole of the spleen. Tech Coloproctol 2012; 16:473; author reply 475. [PMID: 22936585 DOI: 10.1007/s10151-012-0877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
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14
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Incidental finding of a splenic hamartoma with tumour-like extramedullary erythropoiesis. Wien Med Wochenschr 2012; 161:394-7. [PMID: 21953431 DOI: 10.1007/s10354-011-0019-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/24/2011] [Indexed: 12/19/2022]
Abstract
Hamartomas of the spleen are rare benign tumour-like lesions that tend to be asymptomatic incidental findings. Splenic hamartomas with tumour-like extramedullary erythropoiesis are extremely rare. A 70-year-old male patient with dyspnoea and a nodular intrapulmonary lesion morphologically verified by CT underwent fibre bronchoscopy, which showed a pea-shaped foreign body that was retrieved without complication. As a secondary finding, the CT showed a splenic lesion of about 8 cm in size. An MR study showed an expansive process in the center of the spleen. The patient was completely free of clinical symptoms. Because of the unknown nature and the high risk for spontaneous rupture of the lesion, a splenectomy was performed. The histological analyses revealed tumour-like extramedullary erythropoiesis of the spleen. The patient was discharged in good condition ten days postoperatively. A hamartoma of the spleen with extramedullary tumor-like erythropoiesis should be considered in the differential diagnosis of a splenic lesion.
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15
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Total Splenectomy due to an Unexpected "Complication" after Successful Extended Laparoscopic Partial Decapsulation of a Giant Epidermoid Splenic Cyst: A Case Report. Case Rep Med 2011; 2011:318208. [PMID: 21687593 PMCID: PMC3114453 DOI: 10.1155/2011/318208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 04/13/2011] [Indexed: 11/23/2022] Open
Abstract
Splenic cysts are rare entities and are classified as true cysts or pseudocysts based on the presence of an epithelial lining. Congenital nonparasitic true cysts can be epidermoid, dermoid, or endodermoid, present at a young age, and are commonly located in the upper pole of the spleen. Surgical treatment is recommended for symptomatic, large (more than 5 cm), or complicated cysts. Depending on cyst number, location, relation to hilus, and the major splenic vessels, the surgical options include aspiration, marsupialization, cystectomy, partial cystectomy (decapsulation), and partial or complete splenectomy. Laparoscopic techniques have now become the standard approach for many conditions, including the splenic cysts, with emphasis on the spleen-preserving minimally invasive operations. We present the successful extended partial laparoscopic decapsulation of a giant epidermoid splenic cyst in a young female patient that, although asymptomatic, was unfortunately followed by complete splenectomy five days later due to a misinterpreted abdominal CT suggesting splenic postoperative ischemia.
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16
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Olakkengil SA, Norwood MG, Strickland AD, Behnia-Willison F, Mohan Rao M, Hewett PJ. Perspectives of Laparoscopic Donors Toward a New Procedure: Transvaginal Donor Nephrectomy. J Laparoendosc Adv Surg Tech A 2010; 20:803-6. [DOI: 10.1089/lap.2010.0291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Santosh Antony Olakkengil
- Departments of Renal Transplant, Surgery, and Gynaecology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael G.A. Norwood
- Departments of Renal Transplant, Surgery, and Gynaecology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew D. Strickland
- Departments of Renal Transplant, Surgery, and Gynaecology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Fariba Behnia-Willison
- Departments of Renal Transplant, Surgery, and Gynaecology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Manchala Mohan Rao
- Departments of Renal Transplant, Surgery, and Gynaecology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J. Hewett
- Departments of Renal Transplant, Surgery, and Gynaecology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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Development of an ex vivo simulated training model for laparoscopic liver resection. Surg Endosc 2010; 25:1677-82. [DOI: 10.1007/s00464-010-1440-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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18
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Strickland AD, Norwood MGA, Behnia-Willison F, Olakkengil SA, Hewett PJ. Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women's views on a new technique. Surg Endosc 2010; 24:2424-31. [PMID: 20224999 DOI: 10.1007/s00464-010-0968-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/03/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic and minimally invasive surgery has changed the surgical landscape irrevocably. Natural orifice translumenal endoscopic surgery (NOTES) offers the possibility of surgery without visible scars. Transvaginal entry offers potential benefits because it gains access to the peritoneal cavity without the need to open an abdominal viscus. Much of the discussion pertaining to NOTES focuses on technical and training issues, with little attention to date paid to the opinions of women. The perceptions of female health care workers and patients were sought in relation to their views on transvaginal NOTES. METHODS This study surveyed 300 women using a 12-point questionnaire devised by a multidisciplinary group of surgeons interested in minimally invasive surgery. The questionnaire was designed to establish the opinions of women with respect to NOTES surgery versus standard laparoscopic procedures. Responses were de-identified. RESULTS Three-fourths of the women surveyed were neutral or unhappy about the prospect of a NOTES procedure, and this remained constant even when it was stipulated that laparoscopic cholecystectomy and NOTES had equivalent safety and efficacy. Younger nulliparous women were most concerned about the potential negative effect of NOTES on sexual function. A minority were concerned about the cosmetic effect of surgery, although surgical scars were perceived as more important to younger respondents. CONCLUSIONS Potentially, NOTES surgery offers women a scarless operation with the possibility of less pain than experienced in standard laparoscopic surgery. Few women, however, were troubled about the cosmetic effect of surgery. The effect of NOTES on sexual function was expressed as a particular concern by younger women. In all groups and across all ages, peritoneal access using the transvaginal route was met by significant scepticism. In Australia, women remain to be convinced about the potential advantages of the emerging NOTES technology.
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Affiliation(s)
- Andrew D Strickland
- Department of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville Road, Woodville, Adelaide, SA, 5011, Australia
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19
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Szczepanik AB, Meissner AJ. Partial splenectomy in the management of nonparasitic splenic cysts. World J Surg 2009; 33:852-6. [PMID: 19172349 DOI: 10.1007/s00268-008-9868-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recognition of the importance of the spleen in immunological function and the potential threat of severe postsplenectomy complications have led to the development of parenchyma-preserving surgical procedures. The aim of the present study was to assess the impact of open splenic partial resection on the management of splenic cysts. PATIENTS AND METHODS From April 2003 to June 2007, 11 patients with splenic cysts were evaluated. All patients fulfilled the criteria for surgical resection. Ten of the patients (6 women and 4 men) 15-42 years of age (mean: 26.4 years) were subjected to open partial splenectomy. In one patient, a centrally located splenic cyst was considered unsuitable for partial splenectomy, and the patient therefore underwent total spleen excision. Patients with splenic cysts constituted 3.8% of all 290 patients subjected to splenectomy during the study period. Spleen parenchyma was cut with the aid of a LigaSure instrument. Bleeding from the transected splenic parenchyma was secured with argon plasma coagulation and absorbable tape sutures or oxidized cellulose. RESULTS Nine of the ten patients underwent successful partial splenectomy. In one patient, insufficient arterial supply to the preserved splenic remnant after excision of the upper cyst-containing splenic pole led to total splenectomy. The mean operative time was 98 min (range: 85-160 min), and mean blood loss was 106 ml (55-200 ml). The mean cyst diameter was 9.1 cm (range: 7-17 cm) and weight was 738 g (range: 230-2,420 g). The postoperative course was uneventful in all cases. Pathological examination showed an epithelial cyst in 8 patients and a pseudocyst in 2. After a mean follow-up of 26.4 months, the size of the splenic remnant constituted, on average, 71% of preoperative spleen size. Moreover, normal splenic vein flow was observed. Platelet counts remained within the normal range, and no cyst recurrence was observed. There were no infections documented during the follow-up period. CONCLUSIONS Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.
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Affiliation(s)
- Andrzej B Szczepanik
- Department of General and Haematological Surgery, Institute of Haematology and Transfusion Medicine, 5 Chocimska Street, Warsaw, 00957, Poland.
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20
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Rutherford SC, Andemariam B, Philips SM, Elstrom RL, Chadburn A, Furman RR, Niesvizky R, Martin P, Fahey TJ, Coleman M, Goldsmith SJ, Leonard JP. FDG-PET in prediction of splenectomy findings in patients with known or suspected lymphoma. Leuk Lymphoma 2009; 49:719-26. [DOI: 10.1080/10428190801927387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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21
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En Bloc Mobilization of the Pancreas and Spleen to Facilitate Resection of Large Tumors, Primarily Renal and Adrenal, in the Left Upper Quadrant of the Abdomen: Techniques Derived from Multivisceral Transplantation. Eur Urol 2009; 55:1106-11. [DOI: 10.1016/j.eururo.2008.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 12/25/2008] [Indexed: 11/19/2022]
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22
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Laparoscopic partial splenic resection in hydatid disease. Eur Surg 2009. [DOI: 10.1007/s10353-009-0458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Gumbs AA, Bouhanna P, Bar-Zakai B, Briennon X, Gayet B. Laparoscopic partial splenectomy using radiofrequency ablation. J Laparoendosc Adv Surg Tech A 2008; 18:611-3. [PMID: 18721016 DOI: 10.1089/lap.2007.0194] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Epidermoid cysts are believed to be congenital in origin and often present in the pediatric population. Because of the concerns of compromised immunologic function after total splenectomy and increasing demand for minimally invasive approaches, interest has increased in performing the partial splenectomy in this patient population by laparoscopic techniques. Nonetheless, concerns for adequate hemostasis have limited its widespread adoption. Because radiofrequency ablation for the partial splenectomy has been done in a laparoscopic porcine model with good results, we used this technology with the goal of limiting blood loss and postoperative hemorrhagic complications. CASE REPORT A 25-year-old female presented with complaints of right shoulder pain. Abdominal ultrasound and a computed tomography (CT) scan revealed a 10-cm cystic lesion of the spleen. Serology was negative for hydatid cyst pathology. The patient underwent an uneventful partial splenectomy by minimally invasive techniques with the aid of a laparoscopic radiofrequency ablative device and the placement of a hemostatic medicated sponge along the line of transection. RESULTS Estimated blood loss was less than 30 mL. Final pathology was consistent with an epidermoid splenic cyst, and the patient was discharged uneventfully on postoperative day 5. DISCUSSION Techniques for the treatment of symptomatic splenic cysts range from total splenectomy to cyst fenestration and placement of the omentum in the splenic defect. The use of radiofrequency ablation has been traditionally used for hepatic parenchymal transection but seems equally suited for the partial splenectomy. This technology, and the addition of hemostatic sponges, seems to provide excellent results in minimizing blood loss, intraoperatively and postoperatively, during the laparoscopic partial splenectomy; however, randomized, prospective trials will be necessary to see if they will be superior to traditional techniques.
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Affiliation(s)
- Andrew A Gumbs
- Department of Medical and Surgical Digestive Diseases, Institut Mutualiste Montsouris, University Paris V, Paris, France
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25
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Laparoscopic Treatment of Simultaneous Splenic Lymphangioma and Non-Hodgkin's Lymphoma: Report of a Case. TUMORI JOURNAL 2008; 94:608-11. [DOI: 10.1177/030089160809400429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report, to the best of our knowledge, the first case of simultaneous splenic lymphangioma and non-Hodgkin's B-cell lymphoma with liver and bone marrow involvement arising in a 69-year-old woman suffering from chronic hepatitis C infection treated with laparoscopic splenectomy followed by polychemotherapy. After 22 months from surgical treatment, the patient is alive without signs of residual disease. According to our experience, laparoscopic splenectomy followed by polychemotherapy seems to be an effective treatment for simultaneous splenic lymphangioma and non-Hodgkin's B-cell lymphoma.
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Comparison of laparoscopic vs. open access surgery in patients with rectal cancer: a prospective analysis. Dis Colon Rectum 2008; 51:385-91. [PMID: 18219531 DOI: 10.1007/s10350-007-9178-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 05/17/2007] [Accepted: 10/17/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE Laparoscopic surgery of colon cancer has been accepted to be oncologically adequate compared with open resection. However, the situation in rectal cancer remains unclear, because anatomy and complex surgical procedures might specifically influence the long-term outcome. This study was designed to analyze perioperative and long-term outcome of patients with rectal cancer after laparoscopic vs. open access surgery. METHODS A total of 389 patients (1998-2005) were prospectively analyzed; 114 patients had laparoscopic beginning, and 25 patients had conversion and were separately analyzed. Eighty-nine patients remained in the laparoscopic group and 275 had open access surgery. RESULTS Both groups were comparable regarding age, gender, tumor localization, stage, and complications. Differences were found in harvested lymph nodes (laparoscopic 13.5/open access 16.9; P = 0.001) and hospitalization (15.1/18.7 days; P = 0.037). Local recurrence rate and metachronous metastasis were comparable. In patients with deep anterior resection with total mesenteric excision, favorable long-term survival in the laparoscopic group was found (P = 0.035, log-rank). CONCLUSIONS Minimally invasive surgery is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization and faster recovery. Especially in patients with low rectal cancer, minimally invasive surgery with exact preparation of the total mesenteric excision seems to be favorable compared with open access surgery.
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Feldman LS, Demyttenaere SV, Polyhronopoulos GN, Fried GM. Refining the Selection Criteria for Laparoscopic Versus Open Splenectomy for Splenomegaly. J Laparoendosc Adv Surg Tech A 2008; 18:13-9. [PMID: 18266568 DOI: 10.1089/lap.2007.0050] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liane S. Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sebastian V. Demyttenaere
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gerry N. Polyhronopoulos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gerald M. Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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28
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Breitenstein S, Scholz T, Schäfer M, Decurtins M, Clavien PA. Laparoscopic partial splenectomy. J Am Coll Surg 2006; 204:179-81. [PMID: 17189129 DOI: 10.1016/j.jamcollsurg.2006.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2006] [Revised: 10/02/2006] [Accepted: 10/04/2006] [Indexed: 11/30/2022]
Affiliation(s)
- Stefan Breitenstein
- Department for Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
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29
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Dominguez EP, Choi YU, Scott BG, Yahanda AM, Graviss EA, Sweeney JF. Impact of morbid obesity on outcome of laparoscopic splenectomy. Surg Endosc 2006; 21:422-6. [PMID: 17103267 DOI: 10.1007/s00464-006-9064-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 07/31/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of the obesity epidemic, surgeons are operating on morbidly obese patients in increasing numbers. The aim of this study was to evaluate the impact of morbid obesity on the outcome of laparoscopic splenectomy. METHODS The study group consisted of 120 consecutive patients who underwent laparoscopic splenectomy for benign and malignant disease from March 1996 to May 2005. These patients were retrospectively divided into three groups. Group 1 had a body mass index (BMI) < 30. Group 2 patients had a BMI > or = 30 and < 40 and were considered obese. Group 3 had a BMI > or = 40 and were considered morbidly obese. Data including surgical approach (laparoscopic vs. hand-assisted), operative time, conversion rate, estimated blood loss, splenic weight, length of stay, time to tolerate a diet, pathologic diagnosis, complications, and mortality were recorded. RESULTS Complete data were available for evaluation of 112 patients of whom 73 (65%) had a BMI < 30, 32 (29%) had a BMI > or = 30 and < 40, and 7 (6%) had a BMI > or = 40. The most frequent indication for splenectomy in all three groups was idiopathic thrombocytopenic purpura (ITP). The operative times were significantly higher in patients with a BMI > 40. Conversion rates were also higher in this group, although this did not reach statistical significance. Patients with a BMI > 30 experienced similar complication rates when compared with patients with a BMI < 30. Only when patients had a BMI > 40 did they experience more complications. CONCLUSIONS Laparoscopic splenectomy was performed safely in obese patients (BMI > 30) with similar results to those of nonobese patients. Only in morbidly obese patients (BMI > 40) do outcomes and complications appear to be affected. Obesity should not be a contraindication to laparoscopic splenectomy.
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Affiliation(s)
- Edward P Dominguez
- Section of Minimally Invasive Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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30
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Uranues S, Grossman D, Ludwig L, Bergamaschi R. Laparoscopic partial splenectomy. Surg Endosc 2006; 21:57-60. [PMID: 17031738 DOI: 10.1007/s00464-006-0124-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Accepted: 07/05/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND The immunologic function of the spleen and its important role in immune defense has led to splenic-preserving surgery. This study aimed to evaluate whether laparoscopic partial splenectomy is safe. METHODS Data on consecutive patients presenting with localized benign or malignant disease of the spleen were included in a prospective database. The surgical technique consisted of six steps: patient positioning and trocar placement, mobilization of the spleen, vascular dissection, parenchymal resection, sealing/tamponading of the transected edge, and removal of the specimen. RESULTS From 1994 to 2005, 38 patients underwent laparoscopic partial splenectomy. The indications included splenomegaly of unknown origin, splenic cysts, benign tumors (hamartoma), and metastasis from ovarian carcinoma and schwannoma. The median operating time was 110 min (range, 65-148 min). The median length of hospital stay was 5 days (range, 4-7 days). There was no postoperative mortality. Postoperative pleural effusion occurred in two patients. There were no reoperations. Three patients required blood transfusions. CONCLUSION Laparoscopic partial splenectomy is safe for patients with localized benign or malignant disease of the spleen.
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Affiliation(s)
- S Uranues
- Department of Surgery, Lehigh Valley Hospital, Penn State University Clinical Campus, 1240 South Cedar Crest Boulevard, Suite 210, Allentown, PA 18103, USA.
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Khelif K, Maassarani F, Dassonville M, Laet MHD. Laparoscopic Partial Splenectomy Using Radiofrequency Ablation for Nonparasitic Splenic Cysts in Two Children. J Laparoendosc Adv Surg Tech A 2006; 16:414-7. [PMID: 16968196 DOI: 10.1089/lap.2006.16.414] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Nonparasitic splenic cysts are uncommon lesions, for which partial splenectomy offers a definitive treatment while preserving splenic function. We report the use of radiofrequency energy for laparoscopic partial splenectomy to treat two children with nonparasitic splenic cysts by creating a 1-cm thick coagulated parenchyma resection plane, allowing bloodless splenic transection. This approach spares the need for blood transfusions, reduces hospital stay, and offers great promise for partial splenectomy in children.
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Affiliation(s)
- Karim Khelif
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium.
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