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Rabinovich E, Pradhan K, Islam I, Davido HT, Gali R, Muscarella P, Billett HH. Splenomegaly and Response to Splenectomy in Immune Thrombocytopenia. J Clin Med 2024; 13:3712. [PMID: 38999278 PMCID: PMC11242855 DOI: 10.3390/jcm13133712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder affecting patients of all ages and backgrounds. While current standards favor medical therapy in the frontline setting, splenectomy remains an integral part of treatment in refractory cases. Ideal parameters for patient selection for surgery remain elusive. Methods: Data for 40 adult patients undergoing splenectomy for ITP at a large urban center between 1 January 2010 and 1 July 2021 were collected and analyzed. Results: Most patients underwent uneventful laparoscopic splenectomy (95%). Complete or partial response at the time of last follow-up occurred in most patients (92.5%), with 60.0% requiring no additional medical therapy following surgery. Thrombosis was the predominant adverse event and the leading cause of death for two patients. Age and presence of splenomegaly appear to be associated with response to splenectomy. Conclusions: Splenectomy remains an effective therapy for selected patients with ITP. Predictors of positive response to splenectomy, such as younger age and the presence of splenomegaly, may help inform clinicians during patient selection for therapy. With strict attention paid to postoperative thromboprophylaxis, the diminishing use of splenectomy may not be warranted.
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Affiliation(s)
- Emma Rabinovich
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Kith Pradhan
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Iffath Islam
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Helen Tracy Davido
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Radhika Gali
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Peter Muscarella
- Department of Surgery, Niagara Falls Memorial Medical Center, Niagara Falls, NY 14301, USA
| | - Henny H Billett
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
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2
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Delgado-Miguel C, Camps JI. Simultaneous Robotic-Assisted Splenectomy and Cholecystectomy in Children: Is It Safe and Effective? J Laparoendosc Adv Surg Tech A 2024; 34:438-442. [PMID: 37976218 DOI: 10.1089/lap.2023.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Hematologic conditions such as hereditary spherocytosis, sickle cell disease, and idiopathic thrombocytopenic purpura are frequently linked to cholelithiasis. In instances where symptoms are present, simultaneous cholecystectomy and splenectomy are commonly recommended. Our aim was to assess the outcomes of robotic-assisted procedures conducted for simultaneous surgical issues involving the spleen and gallbladder in pediatric patients. Materials and Methods: We have made a simultaneous retrospective study of children with hereditary hematological diseases who underwent combined robotic-assisted splenectomy and cholecystectomy at our institution from January 2010 to December 2021. Demographics, clinical features, intraoperative data, length of hospital stay, postoperative complications, and follow-up outcomes were analyzed. Results: A total of 11 patients (6 male; 5 female) were included, with a mean age of 13.9 ± 4.4 years (range 8-17). Hereditary spherocytosis was the most common disease (7 cases), followed by sick cell disease (4 cases), with associated symptomatic gallbladder litiasis in all of them. Both operations were carried out using the da Vinci® Surgical Si System in a single docking robotic platform (four robotic arms). Median total surgery time was 145 minutes (Q1-Q3: 115-162). Minimal intraoperative bleeding was recorded (mean 45 ± 15 mL), with no intraoperative complications or conversion. Median length of hospital stay was 3 days (Q1-Q3: 2-4). There were no cases of surgical wound infections or postoperative bleeding documented. Conclusion: Simultaneous robotic-assisted splenectomy and cholecystectomy can be considered safe and feasible interventions in children with hematological diseases that affect both the spleen and the gallbladder. However, further research is needed to enhance the existing evidence and establish a standardized approach.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, USA
- Institute for Health Research (IdiPaz), La Paz University Hospital, Madrid, Spain
| | - Juan I Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, USA
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3
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Lombardi PD, Li ASR, Sue MS, Bola HS, Bentley DC. Atypically Taut Superior Polar Splenic Artery Discovered in a Human Cadaver. Cureus 2023; 15:e49627. [PMID: 38033438 PMCID: PMC10687485 DOI: 10.7759/cureus.49627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/02/2023] Open
Abstract
The splenic artery is the largest branch of the celiac trunk and frequently presents with anatomical variability. These variations relate to its origin, trajectory, location relative to the pancreas, terminal branching pattern, and the potential presence of polar arteries. Knowledge of the splenic artery's variability may inform gastrointestinal surgeons as they plan and execute surgical interventions, resulting in improved success rates while minimizing both operative complications and procedural time. The case presentation of a splenic artery dissected from an elderly male cadaver initially demonstrated normal anatomical arrangement. The artery branched off the celiac trunk of the abdominal aorta and followed a tortuous suprapancreatic route to split into two lobar arteries terminating in the spleen. However, upon closer inspection, a superior polar splenic artery was uncovered with two unique characteristics. Firstly, the presented polar artery lacked branching gastric arteries, a rare variation with a prevalence of only 3.27%. Secondly, the distance between the origin of the superior polar splenic artery and the splenic hilum was greater than what is often reported in clinical literature. While similar previous case reports have observed arterial origins of greater distance, these have often been accompanied by a compensatory arterial length. Interestingly, the case presented in this report contained a superior polar splenic artery with an arterial length shorter than its distance to the splenic hilum, resulting in an atypically taut vessel. This bears clinical importance, as this arterial presentation may be susceptible to a surgical rupture if neglected. By including this anatomical variation in the expanding library of splenic artery variations, surgeons and their collaborative healthcare teams may broaden their understanding of splenic artery anatomy as they conceptualize new techniques for pancreatomy and splenectomy procedures that consider arterial variations while minimizing surgical complications, operative time, and patient blood loss.
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Affiliation(s)
| | - Annie Shi Ru Li
- Faculty of Arts & Science, University of Toronto, Toronto, CAN
| | - Michelle S Sue
- Faculty of Arts & Science, University of Toronto, Toronto, CAN
| | - Harun S Bola
- Faculty of Medicine, Department of Surgery, Division of Anatomy, University of Toronto, Toronto, CAN
| | - Danielle C Bentley
- Faculty of Medicine, Department of Surgery, Division of Anatomy, University of Toronto, Toronto, CAN
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4
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Baldari L, Boni L, Giuliani B, Cassinotti E. Porto-spleno-mesenteric venous thrombosis after elective splenectomy: a retrospective cohort study. Front Immunol 2023; 14:1216283. [PMID: 37928557 PMCID: PMC10625444 DOI: 10.3389/fimmu.2023.1216283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Elective splenectomy is the main treatment for a wide range of haematological diseases. Porto-spleno-mesenteric venous thrombosis represents one of the most severe complications of this procedure. The aim of this study was to evaluate risk factors associated with development of porto-spleno-mesenteric venous thrombosis after elective splenectomy. Methods All cases of elective splenectomy carried out from April 1st 2017 to January 31st 2023 were included in this single centre retrospective cohort study. Patients' demographics and perioperative data were analysed and correlated with the incidence of postoperative thrombosis. All patients underwent postoperative doppler ultrasound screening for thrombosis. Analysis was performed using SPSS 28, with p-value < 0.05 considered significant. Results Twenty-two patients (10 women, 12 men) underwent splenectomy during the study period. Indications were: immune thrombocytopenia (n: 6), myeloproliferative disorder (n: 6), hereditary spherocytosis (n: 4), thalassemia (n: 1), lymphoma (n: 1), leukaemia (n: 1), other malignancies (n: 3). Six patients developed porto-spleno-mesenteric venous thrombosis and only 2 of them were symptomatic. Patients were treated with anticoagulation therapy with complete resolution. Analysis identified three main factors associated with thrombosis: spleen diameter (p = 0.03), myeloproliferative disorder (p = 0.02), intraoperative platelet transfusion (p = 0.002) and intraoperative red blood cells transfusion (p = 0.009). Conclusion Standardized postoperative screening allows prompt diagnosis and treatment of porto-spleno-mesenteric venous thrombosis even in asymptomatic cases. Patient with splenomegaly and affected by myeloproliferative disorder have a greater risk to develop this complication.
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Affiliation(s)
- Ludovica Baldari
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Boni
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunitá, Univeristy of Milan, Milan, Italy
| | - Beatrice Giuliani
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Cassinotti
- Department of General and Minimally-Invasive Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunitá, Univeristy of Milan, Milan, Italy
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5
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Poddar P, Shylasree TS, Bhandare M. Splenectomy and Distal Pancreaticosplenectomy: Surgical Anatomy and Technique Specific to Advanced Ovarian Cancer. Indian J Surg Oncol 2023; 14:252-263. [PMID: 36891436 PMCID: PMC9986191 DOI: 10.1007/s13193-021-01412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 07/28/2021] [Indexed: 10/20/2022] Open
Abstract
Ovarian cancer is one of the most aggressive malignancies in women and usually presents at an advanced stage. Complete tumor debulking and platinum sensitivity are the two important determinants of survival in ovarian cancer. Upper abdominal surgery with bowel resections and peritonectomy are usually needed to achieve optimal cytoreduction. Splenic disease in the form of diaphragmatic peritoneal disease or omental caking at the splenic hilum is not infrequent. Around 1-2% of these require distal pancreaticosplenectomy (DPS) and the decision to perform DPS versus splenectomy should be made early in the intraoperative period to prevent unnecessary hilar dissection and bleeding. We hereby describe the surgical anatomy of the spleen and pancreas and point of technique of splenectomy and DPS specific to advanced ovarian cancers.
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Affiliation(s)
- Pabashi Poddar
- Department of Gynecological Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernst Borges Marg, Parel, Mumbai, 400012 Maharashtra India
| | - T. S. Shylasree
- Department of Gynecological Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernst Borges Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Manish Bhandare
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernst Borges Marg, Parel, Mumbai, 400012 Maharashtra India
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6
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Lasheen O, Yehia M, Salah A, Mikhail S, Hassan A. Towards cost saving in surgery without compromising safety: stapleless laparoscopic splenectomy in a developing country-a prospective cohort study. BMJ Open Qual 2023; 12:bmjoq-2022-002068. [PMID: 36707124 PMCID: PMC9884886 DOI: 10.1136/bmjoq-2022-002068] [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] [Received: 07/26/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Minimally invasive surgery has been steadily growing in popularity. Control of splenic hilar vessels is the most delicate step during laparoscopic splenectomy (LS). In the earlier eras of LS, hilar vessels were controlled using clips and/or ligation. Laparoscopic staples were later introduced and have arguably led to an increase in popularity of LS. They do not abolish potential complications of splenectomy and theoretically represent an added operative cost.In this study, we aimed to assess the safety and efficacy of stapleless LS (using knots, haemostatic devices and clips) compared with the now more conventional stapled LS. METHODS A pilot randomised prospective study was conducted in a university hospital between September 2018 and April 2020. It included 40 patients randomly assigned to two equal groups: (1) 20 patients: stapleless LS and (2) 20 patients: LS using laparoscopic staples.We compared operative time, intra and postoperative complications and postoperative recovery. RESULTS There was no statistically significant difference between both groups across all comparative outcomes. CONCLUSION Both techniques are comparable in terms of safety and operative time. In terms of cost efficiency, we recommend more comprehensive analyses of hospital costs.
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Affiliation(s)
- Omar Lasheen
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Mohamed Yehia
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ayman Salah
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Sameh Mikhail
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed Hassan
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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7
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Bishop AA, Krohn E, Vakayil VR, Pribyl K, Reding MT, Tignanelli C, Harmon JV. A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report. Clin Case Rep 2023; 11:e6831. [PMID: 36703775 PMCID: PMC9869644 DOI: 10.1002/ccr3.6831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/04/2022] [Accepted: 12/13/2022] [Indexed: 01/25/2023] Open
Abstract
We report long-term follow-up of a patient who underwent a tailored laparoscopic procedure for symptomatic cholelithiasis, massive splenomegaly, and a planned pregnancy. There were no complications, and the patient remained symptom-free at the 5-year follow-up. We supplemented our case report with national surgical data demonstrating the safety of laparoscopic splenectomy.
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Affiliation(s)
| | - Eric Krohn
- Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Kyle Pribyl
- Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Mark T. Reding
- Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - James V. Harmon
- Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
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8
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Swinson B, Waters PS, Webber L, Nathanson L, Cavallucci DJ, O'Rourke N, Bryant RD. Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors. Surg Endosc 2021; 36:3332-3339. [PMID: 34331132 DOI: 10.1007/s00464-021-08649-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Minimally invasive splenectomy is now well established for a wide range of pathologies. Portal vein thrombosis (PVT) is increasingly being recognised as a complication of splenectomy. The aim was to determine the incidence and risk factors for PVT after laparoscopic splenectomy. METHODS All cases of elective laparoscopic splenectomy performed from 1993 to 2020 were reviewed. Parameters recorded included demographics, diagnostic criterion and post-operative outcomes. Data were analysed using Minitab V18 with a p < 0.05 considered significant. RESULTS 210 patients (103 female, 107 male) underwent laparoscopic splenectomy (14 to 85 years). A major proportion of cases were performed for ITP (n = 77, p = 0.012) followed by lymphoma (n = 28), indeterminate lesions (n = 21) and myelofibrosis (n = 19). Ten patients developed symptomatic portal vein thrombosis (4.8%). Patients presented most commonly with pain and fever and diagnosis was confirmed by computed tomography (CT) or ultrasonography (USS). There were 10 conversions (4.8%) to open and two postoperative deaths, one from PVT and one from pneumonia. The remaining nine patients were successfully treated with anticoagulation. Of 19 patients with myelofibrosis, six patients developed PVT (p = 0.0002). Patients who developed PVT had significantly greater specimen weights (1773 g vs 348 g, p < 0.001). Forty-three patients had a specimen weight of 1 kg or greater, and of these 9 developed portal vein thrombosis (21%), versus one with PVT of 155 with a specimen weight of less than 1 kg (p < 0.0001). Myelofibrosis (p = 0.0039), specimen weight (p < 0.001) and mean platelet count (p = 0.0049) were predictive of PVT. CONCLUSION A high index of suspicion for this complication should be maintained and prompt treatment with anticoagulation. High-risk patients should be considered for prophylactic anticoagulation and routine imaging of the portal vein.
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Affiliation(s)
- Benjamin Swinson
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Peadar S Waters
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
| | - Laurence Webber
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Les Nathanson
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia
| | - David J Cavallucci
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas O'Rourke
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Richard D Bryant
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,St Vincent's Northside Medical Centre, St Vincent's Private Hospital Northside, 627 Rode Road, Chermside, QLD, 4032, Australia
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9
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Bhat AS, Farrugia A, Muhammad QR, Kulikova V, Marangoni G, Ahmad J. Robotic versus laparoscopic splenectomy: a systematic review of perioperative outcomes. Eur Surg 2021. [DOI: 10.1007/s10353-021-00727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Summary
Background
Elective splenectomy has various indications and can be performed open or minimally invasively. Laparoscopic splenectomy (LS) is popular but has limitations. Some studies suggest potential superiority of robotic splenectomy (RS) over LS. As such, we conducted a systematic review to determine whether RS has greater positive perioperative outcomes in comparison to LS in the adult population.
Methods
We searched for studies that reported perioperative outcomes and compared RS to LS in the adult population. Outcome measures were operative time, conversion to open surgery, postoperative complications, mortality, length of stay, blood loss and cost analysis. A simple, unpaired two-tailed student’s t‑test was used to compare outcomes between the RS and LS patient groups.
Results
After full-text analysis of 47 papers, three studies met the inclusion criteria. The studies involved 72 patients (28 in the RS group, 44 in the LS group). RS demonstrated no significantly reduced blood loss in comparison to LS (p = 0.13). RS had no cases converting to open surgery and no postoperative complications in comparison to LS. No significant difference was found between RS and LS with regards to LOS (p = 0.89) and cost benefit (p = 0.74). RS had a higher operative time in comparison to LS which was not statistically significant (p = 0.45).
Conclusion
The RS approach may be associated with lower blood loss and a lower risk of conversions. There was no statistical difference between RS and LS with regards to length of stay (LOS) and cost. RS takes longer to perform in comparison to LS.
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10
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Qi R, Jin X, Shi H, Wang C, Li H, Shi X. Effect of laparoscopic splenectomy on portal vein thrombosis and serum YKL-40 in patients with cirrhotic portal hypertension. Ann Hepatol 2020; 18:898-901. [PMID: 31427175 DOI: 10.1016/j.aohep.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Laparoscopic splenectomy (LS) is a supportive intervention for cirrhotic patients. However, its efficacy for patients with cirrhotic portal hypertension (CPH) still needs clarification. Studies indicated YKL-40 might be effective targets for treatment of splenomegaly, however deeper insights are unclear. The aim of this study was to investigate the effect of LS on the formation of portal vein thrombosis (PVT) and serum levels of a fibrosis marker, YKL-40, in patients with CPH. MATERIALS AND METHODS A total of 80 patients who underwent LS and 30 healthy controls were investigated in this study. Serum levels of YKL-40 were measured by enzyme-linked immunosorbent assay (ELISA). Demographic characteristics including age and gender were recorded. Clinicopathological and laboratory examinations included the severity of esophageal varices and the presence of viral hepatitis. The liver function was assessed according to the Child-Pugh classification. The incidence of PVT before and after operation was also monitored. RESULTS Serum YKL-40 was significantly increased in CPH patients, and was associated with Child-Pugh score and HBV infection. Furthermore, elderly patients had an increased risk for postoperative PVT. Higher serum YKL-40 was observed in patients with thrombus at postoperative 7, 14 and 21 days than those without thrombus. CONCLUSIONS LS could reduce serum YKL-40 levels and PVT progression and was a useful treatment for patients <40 years of age with CPH.
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Affiliation(s)
- Ruizhao Qi
- Department of General Surgery, 5th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xin Jin
- Department of Hepatobilliary Surgery, 4th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haida Shi
- Department of Hepatobilliary Surgery, 4th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chengfang Wang
- Department of Hepatobilliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Huixing Li
- Department of General Surgery, Aerospace Center Hospital, Beijing, China
| | - Xianjie Shi
- Department of Hepatobilliary Surgery, Chinese PLA General Hospital, Beijing, China.
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11
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Deng ZC, Jiang WZ, Chen L, Tang XD, Liu SH. Laparoscopic VS. Open splenectomy and oesophagogastric devascularisation for liver cirrhosis and portal hypertension: A retrospective cohort study. Int J Surg 2020; 80:79-83. [DOI: 10.1016/j.ijsu.2020.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 12/29/2022]
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12
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Amini SN, Nelson VS, Sobels A, Schoones JW, Zwaginga JJ, Schipperus MR. Autologous platelet scintigraphy and clinical outcome of splenectomy in immune thrombocytopenia: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 153:103040. [PMID: 32712518 DOI: 10.1016/j.critrevonc.2020.103040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
Autologous platelet sequestration pattern is associated with post-splenectomy platelet response in patients with immune thrombocytopenia (ITP). However, published results are contradictory, and have not been systematically reviewed. Our aim is to systematically review and meta-analyse the association between sequestration pattern and post-splenectomy platelet response. Articles were selected from MEDLINE when they a) included ITP patients, b) performed scintigraphy, and c) included post-splenectomy platelet response. The 23 included studies (published between 1969-2018) represented 2966 ITP-patients. Response to splenectomy occurred most frequently in patients with a splenic pattern (87.1 % in splenic versus 47.1 % in mixed and 25.5 % in hepatic patterns). A pooled analysis of 8 studies showed an odds ratio of 14.21 (95 % CI: 3.65-55.37) for platelet response in the splenic versus the hepatic group. Our findings indicate that a splenic sequestration pattern is associated with better response after splenectomy. Platelet sequestration patterns may be useful in the clinical decision-making regarding splenectomy.
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Affiliation(s)
- S N Amini
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands; Department of Immune Hematology & Blood Transfusion, Leiden University Medical Centre (LUMC), Leiden, the Netherlands.
| | - V S Nelson
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands; Department of Immune Hematology & Blood Transfusion, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - A Sobels
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - J J Zwaginga
- Department of Immune Hematology & Blood Transfusion, Leiden University Medical Centre (LUMC), Leiden, the Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - M R Schipperus
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands; Department of Hematology, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
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13
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Aziret M, Koyun B, Karaman K, Sunu C, Karacan A, Öter V, Çelebi F, Ercan M, Bostancı EB. Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy. Turk J Surg 2020; 36:72-81. [PMID: 32637879 DOI: 10.5578/turkjsurg.4535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
Objectives Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique. Material and Methods A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity. Results No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p <0.05) were higher in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to open surgery. Conclusion Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.
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Affiliation(s)
- Mehmet Aziret
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Bülent Koyun
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Kerem Karaman
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Cenk Sunu
- Clinic of Hematology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Alper Karacan
- Clinic of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Volkan Öter
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Fehmi Çelebi
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Metin Ercan
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Erdal Birol Bostancı
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
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14
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Perez A, Perez MEC, Yuga AC, Viray BAG. Splenic lymphangioma in adulthood: A case report. Int J Surg Case Rep 2020; 67:250-253. [PMID: 32086147 PMCID: PMC7029340 DOI: 10.1016/j.ijscr.2020.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Splenic disease are uncommon and primary tumors of the spleen are very rare. These are classified as splenic cyst, benign and malignant tumors. Splenic lymphangioma is a rare, slow-growing benign tumor of the spleen. More often seen in children, it is a congenital malformation of the lymphatic system and is rarely seen in adulthood. When present in adults, it is usually asymptomatic and would be incidentally detected through imaging studies. Infrequently, some patients would present with abdominal pain, distension, nausea, and may have palpable abdominal mass. It may be solitary or may have multiple splenic lesions. PRESENTATION OF CASE We present of a case of splenic mass in a 56-year old female, which remained undetected until incidentally discovered on work-up for chronic back pain. Laparoscopic splenectomy was eventually performed with eventual resolution of the chronic back pain. Histopathologic examination revealed splenic lymphangioma. DISCUSSION Splenic tumors are uncommon. Splenic lymphangiomas presenting in adulthood are extremely rare, and preoperative diagnosis may be difficult in asymptomatic patients. CONCLUSION Surgical removal of splenic lymphangiomas may be necessary to relieve symptoms, prevent complications and confirm diagnosis.
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Affiliation(s)
- Anthony Perez
- Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines; Division of Hepatopancreaticobiliary Surgery, Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines.
| | - Mary Ellen C Perez
- Department of Anesthesiology, University of the Philippines-Philippine General Hospital, Philippines
| | - Ann Camille Yuga
- Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines
| | - Brent Andrew G Viray
- Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines
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15
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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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16
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Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines? Surg Laparosc Endosc Percutan Tech 2019; 29:178-181. [PMID: 30720696 DOI: 10.1097/sle.0000000000000637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to derive some useful parameters to define the feasibility of laparoscopic splenectomy (LS) in massive [spleen longitudinal diameter (SLD)>20 cm] and giant spleens (SLD>25 cm). Between December 1996 and May 2017, 175 patients underwent an elective splenectomy. A laparoscopic approach was used in 133 (76%) patients. Massive spleens were treated in 65 (37.1%) patients, of which 24 were treated laparoscopically. In this subset of massive spleens, the results of laparoscopic splenectomy in massive spleens (LSM) and open splenectomy in massive spleens (OSM) were compared. The clinical outcome of a subgroup of patients with giant spleens was also analyzed. The LSM group resulted in significant longer operative times (143±31 vs. 112±40 min; P=0.001), less blood loss (278±302 vs. 575±583 mL; P=0.007), and shorter hospital stay (6±3 vs. 9±4 d; P=0.004). No conversions were experienced in the LSM group, and the morbidity rate was similar in both the LSM and OSM groups (16.6% vs. 20%; P=0.75). When considering the subset of 9 LSM patients and 26 OSM patients with giant spleens, the same favorable tendency of the laparoscopic group as regards surgical conversion, blood loss, and hospital stay was maintained. The laparoscopic approach can be successfully proposed in the presence of massive splenomegaly also after a careful preoperative evaluation of the expected abdominal "working space." In experienced hands, LS is safe, feasible, and associated with better outcomes than open splenectomy for the treatment of massive and giant spleen, with a maximum SLD limit of 31 cm.
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17
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Milosavljevic V, Veselinovic M, Tadic B, Galun D, Ceranic M, Eric D, Bjelovic M. Laparoscopic Management of Initially Unrecognized Splenic Hydatid Cysts: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2019; 55:medicina55120771. [PMID: 31817008 PMCID: PMC6956320 DOI: 10.3390/medicina55120771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/03/2022]
Abstract
We present a case report that demonstrates diagnostic and intraoperative challenges in the laparoscopic management of initially unrecognized splenic hydatid disease. A male patient, aged 44, was admitted to our department with a big unilocular splenic cyst, radiologically (ultrasonography, computed tomography) characterized as a simple cyst. Serological tests for anti-Echonococcus antibody were negative, and chests X-ray findings were unremarkable, so laparoscopic cyst fenestration with omentoplasty was planned. The intraoperative finding did not correspond to a simple splenic cyst. Hydatid daughter cysts were recognized after the careful opening of the cyst wall. The operation was completed without shifting to open procedures. Laparoscopic partial pericystectomy with omentoplasty is a safe and effective surgical procedure for the management of splenic hydatid disease.
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Affiliation(s)
| | - Milan Veselinovic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Boris Tadic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-62-388-288
| | - Danijel Galun
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Miljan Ceranic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Dragan Eric
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Milos Bjelovic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
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18
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Sulpizio ED, Raghunathan V, Shatzel JJ, Zilberman-Rudenko J, Worrest T, Sheppard BC, DeLoughery TG. Long-term remission rates after splenectomy in adults with Evans syndrome compared to immune thrombocytopenia: A single-center retrospective study. Eur J Haematol 2019; 104:55-58. [PMID: 31594025 DOI: 10.1111/ejh.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Evans syndrome, the combination of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA) or autoimmune neutropenia, is associated with a high rate of relapsed/refractory disease. There are limited data on the efficacy of splenectomy for this condition. We reviewed patient outcomes after splenectomy for Evans syndrome compared to ITP at our institution. METHODS We performed a retrospective analysis of patients who underwent splenectomy for autoimmune cytopenias over a 23-year period with the intention of comparing disease relapse rates after splenectomy in patients with Evans syndrome and in those with ITP. RESULTS During the study period, 77 patients underwent splenectomy for ITP and seven underwent splenectomy for Evans syndrome. In the Evans cohort, splenectomy led to an 85.7% initial response rate with a 42.8% rate of relapse within one year and a long-term (one-year) response rate of 42.8%. In the ITP cohort, the initial response rate was 90.9% with a long-term response rate of 70.1%. CONCLUSION Our data suggest that long-term remission rates after splenectomy are lower in adults with Evans syndrome compared to those with ITP, although splenectomy may still be an acceptable treatment for certain patients with Evans syndrome. Our findings underscore the need for further research and development of additional therapeutic strategies for this patient population.
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Affiliation(s)
- Emilio D Sulpizio
- Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
| | - Vikram Raghunathan
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Tarin Worrest
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Brett C Sheppard
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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19
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Laparoscopic Vs. Open Surgery in Management of Benign Neoplasms of Spleen—Single Institution Experience. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01974-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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20
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Chen Y, Wang J, Ye Q, Wang Z, Weng W, Zhu J. Fast-track care with intraoperative blood salvage in laparoscopic splenectomy. Sci Rep 2019; 9:9945. [PMID: 31289303 PMCID: PMC6617455 DOI: 10.1038/s41598-019-45865-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/06/2019] [Indexed: 12/25/2022] Open
Abstract
Fast-track surgery is claimed to reduce medical morbidity, eliminate the hospitalization needs, and shorten the convalescence period. Intraoperative bleeding as the main complication is also the primary cause of conversion from laparoscopic to open splenectomy. Intraoperative blood salvage can reduce transfusion requirements, decrease the conversion rate to open, and promote fast-tracking in laparoscopic splenectomy (LS). From November 2007 through December 2016 we collected medical data of 115 LS patients. There were three groups: 54 patients receiving routine care (we marks them as Group RT), 33 patients with fast-track care (Group FT), and 28 receiving fast-track care receiving intraoperative splenic blood salvage and autotransfusion (Group FT + ISBS). These medical data are comprised of included three phases (pre-, intra-, and postoperative). There were significant differences (P < 0.05) between RT, FT, and FT + ISBS groups. The hemoglobin level in Group FT + ISBS was significantly higher than in Group RT and Group FT. Comparing the duration of hospital stay of 3 groups, Group RT stayed for a significantly longer time than Group FT and Group FT + ISBS, Group FT + ISBSmuch shorter than Group FT. Comparing the hospitalization expense, GroupFT + ISBS significantly expended less than Group RT and Group FT. Our study shows that laparoscopic splenectomy with fast-track care is feasible, effective, and safe for patients who require splenectomy. Fast-tracking with intraoperative blood salvage improved the fast-track laparoscopic splenectomy procedure.
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Affiliation(s)
- Yan Chen
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jianwei Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qinghuang Ye
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhijiang Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Weihong Weng
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jinhui Zhu
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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21
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Guadagni S, Gianardi D, Morelli L. Hand-Assisted Splenic Bed Laparoscopic Splenectomy for Massive Splenomegaly Secondary to Portal Hypertension and Liver Cirrhosis. Am Surg 2019. [DOI: 10.1177/000313481908500515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simone Guadagni
- General Surgery Unit Department of Oncology, Transplantation and New Technologies University of Pisa Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit Department of Oncology, Transplantation and New Technologies University of Pisa Pisa, Italy
| | - Luca Morelli
- General Surgery Unit Department of Oncology, Transplantation and New Technologies University of Pisa Pisa, Italy
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22
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Sarwal A, Sharma A, Khullar R, Soni V, Baijal M, Chowbey P. Laparoscopic splenectomy for large splenic pseudocyst: A rare case report and review of literature. J Minim Access Surg 2019; 15:77-79. [PMID: 29794364 PMCID: PMC6293666 DOI: 10.4103/jmas.jmas_82_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Laparoscopic splenectomy is gaining popularity due to less morbidity and minimal operative complications. Nowadays, laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. Splenic pseudocyst due to non-traumatic cause has been very rarely reported in literature. We report an interesting case of a rare large splenic pseudocyst without a history of previous abdominal trauma, treated successfully by laparoscopic technique and discuss literature for the same.
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Affiliation(s)
- Ankush Sarwal
- Max Institute of Minimal Access and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Anil Sharma
- Max Institute of Minimal Access and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Rajesh Khullar
- Max Institute of Minimal Access and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Vandana Soni
- Max Institute of Minimal Access and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Manish Baijal
- Max Institute of Minimal Access and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Pradeep Chowbey
- Max Institute of Minimal Access and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
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Wysocki M, Radkowiak D, Zychowicz A, Rubinkiewicz M, Kulawik J, Major P, Pędziwiatr M, Budzyński A. Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases. J Clin Med 2018; 7:E547. [PMID: 30558132 PMCID: PMC6306709 DOI: 10.3390/jcm7120547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022] Open
Abstract
Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications.
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Affiliation(s)
- Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Dorota Radkowiak
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Anna Zychowicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Jan Kulawik
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
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Hsu WF, Yu CJ, Yeh CC, Huang WH, Peng CY. Splenic cystic lymphangiomatosis in association with omental varices and portal hypertension: A case report. Medicine (Baltimore) 2018; 97:e12552. [PMID: 30290613 PMCID: PMC6200500 DOI: 10.1097/md.0000000000012552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONAL Lymphangiomatosis is rare and benign, and slowly proliferating lymphatic vessels of unknown etiology and visceral lymphangiomatosis involving the spleen is rare. Since lymphangiomatosis may be asymptomatic or present as a sense of fullness, splenic cystic lymphangiomatosis is a disease of little concern. PATIENT CONCERNS A 34-year-old woman suffering from progressive epigastric fullness after oral intake for two weeks. DIAGNOSES Physical examination showed a palpable mass which was more than 10 cm in size over the left hypochondrium. An abdominal computed tomography disclosed marked splenomegaly with multiple cystic lesions in the spleen, causing external compression with right-sided deviation of the adjacent organs and varices in the upper abdomen. Esophagogastroduodenoscopy revealed portal hypertensive gastropathy. INTERVENTIONS Conventional total splenectomy was performed in this patient because of an enlarged spleen and unknown etiology, preoperatively. Upon surgery, splenomegaly with polycystic content and varicose vessels over the omentum were noted. Autologous spleen transplantation was not performed because of limited orthotopic and vascularized spleen. OUTCOMES The patient is doing well 18 months after splenectomy. LESSONS This was a rare case presenting with splenic cystic lymphangiomatosis in association with omental varices and portal hypertension. Splenic cystic lymphangiomatosis should be considered in the differential diagnosis of patients with a palpable painless mass over the left hypochondrium.
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Affiliation(s)
- Wei-Fan Hsu
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital
- Graduate Institute of Biomedical Sciences, China Medical University
| | - Cheng-Ju Yu
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital
| | - Wen-Hsin Huang
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
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25
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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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Hangge PT, Sheaffer WW, Neville M, Wasif N, Gray RJ, Pockaj BA, Stucky CCH. The diagnostic value of splenectomy in patients without a definitive preoperative diagnosis. Am J Surg 2018; 217:78-82. [PMID: 29880389 DOI: 10.1016/j.amjsurg.2018.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to describe the diagnostic value and therapeutic benefit of diagnostic splenectomy. METHODS Retrospective review was performed of patients undergoing splenectomy with an unknown diagnosis (UD), a hematologic malignancy (HM) or idiopathic thrombocytopenic purpura. Surgical indications and postoperative outcomes were evaluated. RESULTS 113 splenectomy patients were identified. Of the UD patients undergoing splenectomy, 46% (n = 16) received a definitive diagnosis postoperatively. A change in diagnosis occurred in 12% (n = 4) of HM patients. Complete symptom relief was observed more often in UD patients who received a definitive diagnosis after splenectomy 69% (n = 11), compared to the 47% (n = 9) who did not receive definitive diagnosis postoperatively. CONCLUSIONS The diagnostic ability of splenectomy was 46% when the diagnosis was unknown preoperatively. Additionally, a majority of patients experienced relief of symptoms postoperatively. Splenectomy may be a useful diagnostic and therapeutic tool in select UD and HM patients.
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Affiliation(s)
- Patrick T Hangge
- Division of Surgical Oncology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - William W Sheaffer
- Division of Surgical Oncology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Matthew Neville
- Department of Biostatistics, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Nabil Wasif
- Division of Surgical Oncology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Richard J Gray
- Division of Surgical Oncology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Barbara A Pockaj
- Division of Surgical Oncology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Chee-Chee H Stucky
- Division of Surgical Oncology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
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Kuroki T, Kitasato A, Tokunaga T, Takeshita H, Taniguchi K, Maeda S, Fujioka H. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today 2018; 48:804-809. [PMID: 29569060 DOI: 10.1007/s00595-018-1655-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Laparoscopic splenectomy (LS) has become the standard operative approach for splenectomy. Portal or splenic vein thrombosis (PSVT) is a serious and common complication after LS, and lethal complications of PSVT can occur when the portal vein is completely occluded by portal vein thrombosis (PVT). We aimed to clarify the predictors of PSVT after LS and to determine which of them were also predictors of PVT. METHODS A total of 56 consecutive patients who underwent elective LS were enrolled in this study. The patients were divided into two groups based on the presence or absence of PSVT after LS. In addition, patients with PSVT were divided into two groups: a PVT group and a non-PVT group. The preoperative and intraoperative clinical data were compared among the groups. RESULTS Thirty (53.6%) patients developed PSVT. The splenic vein diameter was the most useful predictor for the development of PSVT, and 10 mm was an accurate splenic vein diameter cut-off value for use as a predictive factor for PSVT. In addition, the splenic vein diameter was the most useful predictor of the development of PVT from splenic vein thrombosis (SVT), and 14 mm was found to be an accurate cut-off value. CONCLUSION PSVT is a common postoperative complication that is identified on enhanced computed tomography. The splenic vein diameter is not only a predictor of PSVT but also of the development of PVT from SVT.
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Affiliation(s)
- Tamotsu Kuroki
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan.
| | - Amane Kitasato
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Takayuki Tokunaga
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Hiroaki Takeshita
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Ken Taniguchi
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Shigeto Maeda
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Hikaru Fujioka
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
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