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.
Highlights
Splenectomy has generally been the treatment of choice for splenomegaly and hypersplenism since the 1950s1
Open splenectomy is associated with a high risk of intraoperative hemorrhage and postoperative pain, and it is contraindicated in patients who have poor liver function[2]
Combining Laparoscopic splenectomy (LS) with intraoperative blood salvage with autotransfusion retains the advantages of autotransfusion and eliminates the risks associated with homologous transfusion
Summary
Splenectomy has generally been the treatment of choice for splenomegaly and hypersplenism since the 1950s1. Open splenectomy is associated with a high risk of intraoperative hemorrhage and postoperative pain, and it is contraindicated in patients who have poor liver function[2]. FT surgery combines various practices and care regimens in the perioperative period, which include epidural or regional anesthesia, minimally invasive techniques, optimal pain control, preoperative oral nutrition, and postoperative early ambulation[12]. Applying these procedures, fast-tracking can reduce stress responses and organ dysfunction to shorten the recovery time, avoid complications, and decrease cost[13]. Intraoperative phase operation time (minites), volume of intraoperative blood loss and blood autotransfusion, the numbers of conversion to open
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