[Comparison of laparoscopic and open splenectomy]

Laparoscopic Splenectomy for Trauma

Background and Objectives:

The use of laparoscopy in the trauma setting is gaining momentum, with more therapeutic procedures being performed. We evaluated the use of laparoscopic splenectomy among trauma patients with data from the National Trauma Database. We compared outcomes for trauma patients undergoing laparoscopic (LS) versus open splenectomy (OS).

Methods:

From the National Trauma Database (2007 to 2015), we identified all patients who underwent a total splenectomy. Patients who had other abdominal operations were excluded. All patients were categorized into 1 of 2 groups: LS or OS. Outcomes of in-hospital mortality, postoperative length of stay, and incidence of major complications between the 2 groups were compared. Bivariate parametric and nonparametric analyses were performed. Patients were then matched on baseline demographic and injury characteristics by using propensity score matching techniques, and we compared differences by using regression analysis.

Results:

A total of 25,408 patients underwent OS and 113 patients underwent LS (0.44%). Patients were significantly different at baseline, with the LS group being less severely injured. Bivariate analysis revealed no difference in length of stay (9 vs 8 days, P = .62), incidence of major complications (10% vs 15%, P = .24), or mortality (6% vs 11%, P = .23). LS was performed in 29.2% of patients beyond 24 hours from presentation compared with 9.5% in the OS (P < .001). Adjusted multivariate analysis showed no overall difference in outcomes.

Conclusion:

LS for trauma is increasingly being used at many centers throughout the United States. The procedure is safe, with outcomes similar to those of OS in selected trauma patients.

Hepatectomy combined with devascularization for treatment of primary hepatocellular carcinoma with portal hypertension

AIM: To investigate the clinical efficacy of hepatectomy combined with devascularization in the treatment of primary liver cancer with portal hypertension.

METHODS: Fifty hepatocellular carcinoma patients with portal hypertension treated at our hospital between January 2011 and December 2013-12 were randomly divided into either a study group (n = 30) or a control group (n = 20). The control group underwent hepatectomy only, and the study group underwent hepatectomy combined with devascularization. Clinical results were compared between the two groups.

RESULTS: There were no significant differences between the treatment group and control group with regard to white blood cell (WBC) count and platelet (PLT) before treatment (P > 0.05). The WBC and PLT were improved after treatment in both groups, and the improvement was better in the treatment group (P < 0.05). There were no significant differences between the treatment group and control group before treatment with regard to alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TB) and albumin (P > 0.05); all these parameters were improved after treatment in both groups, and there were no statistical significances in these parameters between the two groups after treatment (P > 0.05). The operative time and treatment costs were significantly higher in the treatment group than in the control group (P < 0.05), although there was no significant difference in hospitalization time (P > 0.05). The incidence of complications showed no significant difference between the two groups (16.7% vs 15.0%, P > 0.05).

CONCLUSION: Hepatectomy combined with devascularization is effective in the management of hepatocellular carcinoma patients with portal hypertension.

Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration

Objective

This study investigated the influence of laparoscopic carbon dioxide (CO2) pneumoperitoneum on neonate circulation and respiration.

Methods

The study included neonates undergoing elective laparoscopic abdominal surgery. CO2 insufflation pressure was maintained within 8–14 mmHg for pneumoperitoneum creation. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide ( PETCO2) and maximum inspiratory pressure were monitored continuously. Arterial blood samples were collected: 5 min before pneumoperitoneum creation (baseline); 5, 10, and 20 min after CO2 insufflation; 10 min after CO2 exsufflation; 10 min after surgery. pH, partial pressure of CO2 (PaCO2) and arterial oxygen saturation (SaO2) were also measured.

Results

Thirty-six neonates were included. HR and MAP significantly increased after pneumoperitoneum creation, then decreased to baseline after CO2 exsufflation. PaCO2 and PETCO2 were significantly higher after pneumoperitoneum creation, whereas pH was significantly lower 20 min after pneumoperitoneum creation compared with baseline. No significant differences were observed in SpO2 and SaO2.

Conclusion

CO2 pneumoperitoneum had a significant effect on neonatal circulation and respiration, suggesting that the pneumoperitoneal pressure should be limited within a certain range in neonates undergoing laparoscopic surgery.