Laparoscopic Splenectomy Research Articles

Laparoscopic Staple-less Splenectomy: feasibility and benefits

Background: The surgical procedures of the spleen include open splenectomy (OS) laparoscopic splenectomy (LS). Several techniques for control of splenic vessels during LS have been developed, such as Clips, sutures, bipolar vessel sealing devices as Liga-Sure and ultrasonic devices as Harmonic have. The vessel sealing devices shows some advantages if compared with other methods such as staplers and clips as shorter hospital stay, safer, feasible and excellent cosmetic results. And vessel sealing devices (Liga-Sure) LS is cheap alternative to the use of endo-staplers which is expensive. Objectives: The study is to evaluate feasibility, merits and demerits of staple-less laparoscopic splenectomy in cases of non-traumatic disorders of spleen and assess operative time, need for blood transfusion, rate of conversion to open splenectomy or use stapler, period of hospital stay and associated complications. Patients and Methods: The study was conducted on 32 patients, underwent laparoscopic splenectomy using vessel sealing devices (Ligasure) for splenic pedicle control. Informed consent was obtained for all patients. Results: The study was conducted on 32 patients. 30 patients (93.80%) were females and 2 patients (6.3%) were males. 30 patient with immune thrombocytopenic purpura (ITP) and 2 patients with hereditary spherocytosis (HS). Two cases (6.3%) detected with accessory spleen (splenule) at the splenic hilum. Two cases (6.3%) were converted to open splenectomy. To control bleeding, we used stapler in two cases (6.3%). Cost of staple-less LS is less expensive than stapler laparoscopic splenectomy as the stapler LS is more than staple-less LS by about 12000 EGP (700$). Conclusion: In a report in early 1990s, the dissection of the hilum of the spleen was generally achieved by surgical clips or endo-gastrointestinal staplers. Subsequently, new surgical tools such as ultrasonic devices or bipolar electrosurgical devices such as LigaSure had been employed as supporting device that can seal blood vessels with supra-physiologic burst pressures equal to those obtained with surgical clips or ligatures. We, in this series, believe that it is, with a statistical significance, safe and effective, reduces blood loss, minimize operating time, fewer costs and is a valid. Moreover, it reduced conversion rates in selected patients. Last but not least, the use of the vessel sealing devices (Ligasure) resulted in no post-operative complications or need of blood transfusion.

Challenge in differentiation of pancreatic cystic neoplasms between intraductal papillary mucinous neoplasm and mucinous cystic neoplasm: A case report

AbstractIncidental pancreatic cystic neoplasms (PCNs) are frequently detected as a result of advances in imaging technologies nowadays. Cystic lesions with higher malignant potential include mucinous neoplasms, such as intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). There are crucial differences between MCN and IPMN in their biological behavior and clinical prognosis. However, currently available tools are imperfect to differentiate between IPMN and MCN. We reported a case of a 46‐year‐old woman with incidental pancreatic tail cyst of 8 cm size. Computed tomography scan and endoscopic ultrasound with fine‐needle aspiration showed a tumor located at the pancreatic tail. The macrocystic lesion had septa and peripheral calcification, and cystic fluid analysis revealed high level of carcinoembryonic antigen (CEA) with low level of amylase. These clinical features are suggestive of MCN in previous experience. Patient underwent laparoscopic distal partial pancreatectomy and splenectomy. The final pathological result was IPMN. Following the application of updated 2017 consensus guideline and 2018 American College of Gastroenterology (ACG) guideline will provide more precise preoperative evaluation and postoperative surveillance. We try to explain the discrepancy between the diagnostic modalities, and more cost‐effective, validated biomarkers are required for differentiating PCNs in the future.

Long-term outcomes of oesophagogastric devascularization and splenectomy in patients with portal hypertension and liver cirrhosis.

Research about the long-term outcomes of oesophagogastric devascularization and splenectomy (OGDS) to treat portal hypertension (PH) is scarce. This study aimed to evaluate the safety and long-term treatment efficacy of OGDS, especially in elderly patients. During 2010-2016, open splenectomy and oesophagogastric devascularization (OSOD) and laparoscopic splenectomy and oesophagogastric devascularization were performed in 124 (group A) and 29 (group C) patients diagnosed with PH and liver cirrhosis, respectively. All patients aged less than 65 years. Besides, 39 patients aged 65 years or older undergoing open splenectomy and oesophagogastric devascularization were classified into group B. All clinical data were retrospectively analysed. Compared with group A, patients in group C had longer operative time, less blood loss and shorter post-operative hospitalization time. However, for perioperative data, there was no significant difference between group A and group B. During post-operative follow-up, compared with pre-operative condition, all haematology and liver function parameters significantly changed, except for alanine aminotransferase. For post-operative complications, only the portal vein system thrombosis rate was significantly higher in group C than group A. No significant difference was found in the overall survival rate among three groups, when non-variceal-rebleeding-related deaths were excluded. OGDS remains safe and effective to treat PH secondary to liver cirrhosis and it can be performed successfully in elderly patients and achieve a curative effect that is not inferior to young patients.

The Diagnostic Utility of Splenectomy in Idiopathic Splenomegaly.

With increasing frequency, patients with idiopathic splenomegaly are referred to surgeons for splenectomy. We evaluated the diagnostic utility of splenectomy and feasibility of a minimally invasive approach in the face of idiopathic splenomegaly. We retrospectively reviewed 68 patients who underwent splenectomy for idiopathic splenomegaly. The primary endpoint was the rate of definitive diagnosis based on final surgical pathology of the removed spleen. Preoperative workup included a bone marrow biopsy and peripheral blood smear in 93% and 100% of patients, respectively, with none having lymphadenopathy warranting biopsy. Splenectomy provided a definitive diagnosis for 44 (64.7%) patients. Of these, 34 (50%) patients had an underlying malignancy, of which more than half were splenic marginal zone lymphoma. There were 33 (48.5%) laparoscopic, 23 (33.8%) open, 10 (14.7%) laparoscopic converted to open, and two (2.9%) laparoscopic hand-assist cases. Conversion to open was due to splenic size [median craniocaudal length 21.8cm (cm)] in eight and staple line bleeding at the splenic hilum in two patients. Overall, the laparoscopic approach was completed in patients with a smaller splenic size compared to open (median craniocaudal length 15.2 vs. 26.0cm, p < 0.0001). The open group had one (1.5%) intra-operative mortality due to uncontrollable hemorrhage. Thirty-day complication rates were similar for laparoscopic and open approaches (p = 0.10). Splenectomy is an effective diagnostic modality in determining a pathologic cause for splenomegaly in this patient population. Laparoscopic splenectomy can be performed safely in appropriate cases with craniocaudal splenic size having the largest influence on surgical approach.

Combined laparoscopic and gastroscopic treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophageal varices

Objective To evaluate the efficacy of laparoscopic splenectomy plus pericardial devascularization combined with gastroscopic (double endoscopy) treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophagogastric varices. Methods To retrospectively analyze 108 patients who presented with bleeding esophageal and gastric varices at the First Hospital of Jiaxing from March 2013 to March 2018. Of 108 patients, there were 61 males and 47 females, with an average age of 61 years. According to the disease and desires of patients and family members, 28 patients underwent laparoscopic splenectomy plus devascularization (the laparoscopic group), 43 endoscopic treatment (the endoscopic group) and 37 double endoscopic treatment (the double endoscopic group). The liver function, renal function, hemoagglutination and degrees of recurrence of the three groups were compared after operation. Results The renal function, coagulation function, HbA1c in the double endoscopic group was significantly better than that in the other two groups (P<0.05). In the laparoscopic group, there were 4 patients who presented with rebleeding within 36 months, compared with 3 in the endoscopic group, and no patients in the combined group. At 36 months after operation, gastroscopy performed in the laparoscopic group showed mild varices in 8(28.6%) patients, moderate in 9(32.1%), and severe in 11(39.3%). In the endoscopic group, there were 7(16.3%) patients with mild, 26(60.5%) with moderate, and 10(23.2%) with severe. In the double endoscopic group, there were 32(86.5%) patients with mild and 5(13.5%) with moderate. The degrees of recurrence and postoperative esophageal and gastric varices rebleeding in the double endoscopic group were significantly better than those in the laparoscopic group and the endoscopic group (P<0.05). Conclusion Laparoscopic combined with endoscopic treatment was more effective in patients with cirrhosis and portal hypertension who presented with bleeding esophageal varices. Key words: Laparoscopy; Esophageal and gastric varices; Pericardial devascularization; Splenectomy; Gastroscopy

Gastrointestinal Bleeding due to Pancreatic Disease-Related Portal Hypertension.

Background and Aims Left-sided portal hypertension (LSPH) is a rare type of portal hypertension, which occurs due to obstruction, stenosis, or thrombosis within the splenic vein. Pancreatic diseases are the most common etiology of LSPH. This study is aimed at reporting our experiences and discussing the presentation, management, and prognosis of LSPH secondary to pancreatic diseases. Patients and Methods. We retrospectively reviewed five patients who were diagnosed with LSPH secondary to pancreatic diseases at our department. We collected the demographic information, history, comorbidities, clinical presentations, laboratory tests, esophagogastroduodenoscopy (EGD), images, and outcome data. Results Three elderly patients (>60 years old) were diagnosed with pancreatic cancer, of whom one underwent laparoscopic radical distal pancreatectomy and splenectomy, one received chemotherapy, and another one chose conservative management due to multiple systemic metastases. Two younger patients (<40 years old) were diagnosed with acute recurrent pancreatitis and chronic pancreatitis. Four of these five included patients presented with hematemesis and/or melena at our admission. All patients had gastric varices, and one of them also had esophageal varices. One elderly patient with metastatic pancreatic cancer underwent endoscopic variceal treatment as a rescue therapy but finally died of refractory gastrointestinal (GI) bleeding; another younger patient with chronic pancreatitis died of massive GI bleeding; and the remaining three patients survived at their last follow-up. Conclusions LSPH should be seriously taken into consideration in patients with pancreatic diseases who develop upper GI bleeding. Clinicians should individualize the treatment strategy of LSPH according to the patients' clinical conditions and nature of pancreatic diseases.

Long-Term Evaluation of the Outcomes of Subtotal Laparoscopic and Robotic Splenectomy in Hereditary Spherocytosis.

Hereditary spherocytosis (HS) is a common inherited disease affecting the erythrocyte membrane. Total splenectomy (TS) is effective in reducing hemolysis and decreasing the need of transfusions, but total removal of the spleen represents a potential risk factor for infectious and non-infectious complications. On the other hand, subtotal splenectomy (STS) could be an alternative therapy for HS. The aim of this study is to establish which surgical approach has the best outcome in HS. All patients (n = 63) receiving splenectomy for HS between 2002 and 2016 from one institution were retrospectively reviewed. Hemoglobin and reticulocytes levels during preoperative and postoperative follow-up periods were compared. Additionally, a meta-analysis was performed analyzing data regarding hemoglobin and reticulocytes levels from several available studies. At 1-year follow-up, our clinical data showed that mean hemoglobin levels increased after TS from (mean ± SD) 9.77 ± 1.82 to 11.88 ± 2.08g/dl, while after STS from 8.98 ± 1.66 to 11.87 ± 1.38g/dl. At 3-year and 5-year follow-up after TS, we observed an increase from 9.77 ± 1.82 to 13.59 ± 2.03 and 13.46 ± 1.64g/dl, respectively. At 3-year and 5-year follow-up after STS in our cohort, we observed an increase from 8.98 ± 1.66 to 13.21 ± 1.95 and 13.68 ± 1.65g/dl, respectively. The meta-analysis (for a follow-up period of 1year) showed that the hemoglobin levels increased with 2.61g/dl (95% CI 2.15-3.08g/dl; p < 0.001) after TS, and with 1.67g/dl (95% CI 1.25-2.10g/dl; p < 0.001) after STS. We conclude that subtotal and minimally invasive splenectomy could be considered as the first line of treatment in severe HS cases, especially in children.

Concomitant Laparoscopic Splenectomy and Cholecystectomy: A Systematic Review of the Literature.

Background: Concomitant laparoscopic splenectomy and cholecystectomy (CLSC) is performed for concurrent pathologies of the spleen and gallbladder. This systematic review aimed to evaluate the available evidence on its indications, operative technique, and outcomes. Materials and Methods: The PubMed and Cochrane bibliographical databases were searched from the beginning of time (last search: December 6, 2019) for studies reporting on CLSC. The National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool was utilized for the evaluation of eligible articles. Results: Eight studies met inclusion criteria and concerned collectively 108 patients (53 males and 55 females) with a mean age of 27.02 ± 20.48 years (mean, SD). The most common surgery indications were hereditary spherocytosis (38.9%) and sickle cell disease or β-thalassemia (32.4%). Laparoscopic cholecystectomy preceded splenectomy in the majority of cases (75%). A five-trocar approach was most frequently (89.8%) utilized. The mean operation duration was 170.18 ± 53.07 minutes (mean, SD). Resected spleen weight was 601.82 ± 386.02 g (mean, SD) and had a length of 18.74 ± 5.3 cm (mean, SD). The conversion rate was 2.7%, while 20.4% of included cases experienced postoperative complications. Most frequent ones included pulmonary infection (6.5%) and portal/splenic vein thrombosis (4.6%). No postoperative death was recorded. Mean hospitalization period was 5.43 ± 3.18 days (mean, SD). Conclusions: CLSC is a safe and feasible operation for simultaneous diseases of the spleen and gallbladder that require elective procedures. High-quality clinical trials are essential to further elucidate clinical evidence and standardize operative technique.

İntraoperatif splenik hilus kanaması ve splenomegali robotik ve laparoskopik splenektomiden açık cerrahiye geçişe etki eden risk faktörleridir

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. 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. 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. 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.

Laparoscopic splenectomy in the treatment of the splenic pseudotumor and preservation accessory spleen

Laparoscopic splenectomy in the treatment of the splenic pseudotumor and preservation accessory spleen

EFFICACY OF LAPAROSCOPIC SPLENECTOMY IN THALASSEMIA PATIENTS

Thalassemia is one of the most common monogenic disorders in India. Approximately 7500- 12,000 babies with β-thalassemia major are born every year in the country. [13] Because of the magnitude of the disease and health-care burden it poses, it has been covered as part of various National Programs by the Government of India. Children with features of hypersplenism and increased packed red blood cell (PRBC) transfusion requirement are referred to the pediatric surgical unit for splenectomy. Open splenectomy is performed with utmost care and only when clearly indicated. Regular follow-up assessments are done following splenectomy.&#x0D; The present study was planned in Department of General surgery, Government Doon Medical College, Dehradun, Uttarakhand, India. The study was conducted from March 2018 to June 2019. In the present study 20 patients diagnosed with the thalassemia in which the splenectomy was suggested. A single team were operated all the patients which headed by the second author. Hypersplenism, increased requirement of blood transfusion, haemosiderosis and abdominal discomfort due to splenomegaly revealed as indications for splenectomy. Preoperative blood transfusion were done to correct Hb &gt;10 gm% in all patients. Immunization was done 3 weeks prior to surgery with polyvalent pneumococcal, hepatitis B and H. influenzae B vaccines for all patients.&#x0D; The data generated from the present study concludes that Laparoscopic splenectomy revealed to be feasible and safe procedure to β thalassemia patients with splenomegaly. Pfannenstiel incision for specimen extraction is significantly decrease time, with low morbidity and offer better cosmetic results. The operative time in laparoscopic splenectomy is still longer than the open splenectomy but it decrease with time due to increased experience.&#x0D; Keywords: Laparoscopic splenectomy, Thalassemia, Pfannenstiel incision, etc.

Abstract No. 396 Partial splenic artery embolization: a nonsurgical approach to hypersplenism

Partial splenic embolization (PSE) is a novel percutaneous interventional method and an alternative to open and laparoscopic splenectomy because of its minimally invasive nature and fewer complications. PSE can be particularly useful in high-risk surgical patients allowing preservation normal splenic function and thus avoiding the risk of infections. Retrospective study of 14 patients (8 males and 6 females) in the age group of 10 to 49 years with hypersplenism (massive splenomegaly and Platelet count 10000-60000) referred to IR department for partial splenic artery embolization between October 2013 and October 2018. Baseline data was documented. PSE was performed though transfemoral approach using PVA Particles (355 to 500 microns) sparing one or two sectors to retain 20- 30% of the blood supply and to achieve ∼70% splenic infarction. Intra-arterial gentamycin was given to all patients after splenic artery catheterization. Follow-up for splenic size and complete blood counts were done at one month and six months post procedure and were analyzed. All patients achieved a splenic infarction rate of more than 50% with a significant improvement in platelet count. All patients had a well-maintained splenic function. Post-embolization syndrome was noted in 8 patients which was managed conservatively. There were no major complications identified in any of the patients PSE is a safe and minimally invasive technique having a good long-term effect on the hematological parameters, minimal complications and preservation of normal splenic function.

Laparoscopic versus open Splenectomy in the management of hematological diseases

Laparoscopic versus open Splenectomy in the management of hematological diseases

Treatment options for sclerosing angiomatoid nodular transformation of spleen

BackgroundTo summarise the clinical features of Sclerosing angiomatoid nodular transformation (SANT) of the spleen and to compare the efficacy of three different surgical treatments. MethodsWe performed a retrospective analysis of patients with SANT of spleen treated at our center from 2009 to 2018. We compared the efficacy and safety of three different types of surgical procedures. ANOVA and the chi-square test were used for statistical analysis. ResultsA total of 37 patients were included. Most (35/37; 94.6%) were asymptomatic. A number presented as obscure boundary lesions such that malignancy could not be excluded. Open splenectomy was performed for 12 patients, laparoscopic splenectomy for 12 patients and laparoscopic partial splenectomy for 13 patients. Operation time (P = 0.355), blood loss (P = 0.135), length of hospital stay after operation (P = 0.271) and postoperative complications (P = 0.502) were comparable between the three groups. Duration of drainage tube placement was significantly longer in laparoscopic partial splenectomy patients (P = 0.006). Peak platelet count after operation was significantly lower in laparoscopic partial splenectomy patients (P < 0.001). ConclusionLaparoscopic partial splenectomy appears to be a technically feasible and therapeutically effective approach for SANT.

Laparoscopic partial splenectomy with temporary occlusion of the trunk of the splenic artery in fifty-one cases: experience at a single center.

Laparoscopic partial splenectomy (LPS) for splenic benign space-occupying lesions has been reported by many researchers; however, few studies have described methods to control intraoperative bleeding. Trustworthy experience in LPS with a satisfactory intraoperative hemorrhage control technique is therefore necessary. The current study aims to present our experience in LPS with temporary occlusion of the trunk of the splenic artery for controlling intraoperative bleeding with a large sample of 51 cases and to evaluate the safety, feasibility, and reproducibility of this technique. Fifty-one patients from August 2014 to April 2019 who underwent LPS in our institution were retrospectively analyzed. Surgical techniques were described in detail. All patients had successfully undergone LPS with temporary occlusion of the trunk of the splenic artery. Conversions to open surgery, hand-assisted laparoscopic splenectomies, or blood transfusions were not needed. The operative time was 94.75 ± 18.91min, the estimated blood loss was 71.13 ± 53.87ml, and the volume of resected spleen was 34.75 ± 12.19%. The range of postoperative stays was 4-14days. One female patient (2%, 1/51) suffered from postoperative complications. No perioperative mortality, incision infections, postoperative pancreatic fistulas (POPFs), splenic infarctions, or portal/splenic vein thromboembolic events occurred. LPS is an effective spleen-preserving surgery. Although there are many other bleeding control methods, temporarily occluding the trunk of the splenic artery was found to be a safe, feasible, and reproducible technique in LPS. The outcomes of this technique and the efficacy of splenic parenchyma preservation are acceptable.

Laparoscopic splenectomy for a wandering spleen with resultant splenomegaly and gastric varices.

Laparoscopic splenectomy for a wandering spleen with resultant splenomegaly and gastric varices.

A novel preoperative scoring system to predict technical difficulty in laparoscopic splenectomy for non-traumatic diseases.

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. 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. 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). 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.

Impact of Platelet Counts, Surgical Methods, and Preoperative Platelet Transfusion on the Outcome of Splenectomy for Immune Thrombocytopenia

Introduction: Splenectomy is an important and potentially curative treatment for immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has replaced open splenectomy (OS) as the standard approach. The prognostic role of platelet count and the clinical indication of preoperative platelet transfusion are not entirely clear. Methods: We designed a study to explore the prognostic impact of surgical methods, platelet count, and platelet transfusion in a large, single-institute, long-term cohort of ITP patients. Result: In 118 ITP patients, there was no difference between OS and LS in response and surgical complications. The overall response rate was 77% and the complete response (CR) rate was 70%. Patients with a CR had a trend towards a higher baseline platelet count. A stable platelet count 14–28 days after splenectomy was associated with a sustained long-term response. Patients requiring preoperative platelet transfusion had a lower preoperative platelet count and were more likely to need postoperative transfusion of red blood cells and platelets. They also had a lower postoperative platelet count than the nontransfusion group. Relapse-free survival did not differ. Conclusions: Baseline and postoperative platelet counts are apparently associated with the treatment response to splenectomy but the difference did not reach statistical significance. Preoperative platelet transfusion did not overcome the disadvantage of thrombocytopenia and was not recommended when other preparative measures are available.

Laparoscopic Splenectomy in Children: Safety of Ligasure Usage.

Introduction:Laparoscopic splenectomy started to be more popular and nowadays it is the first choice for splenectomy in children. The main advantages of laparoscopic splenectomy over open approach are the shorter hospital stay, low complications and the cosmetic results despite the main concern of long operative time and the intra operative bleeding. Aim:The aim of this study was to report our experience with laparoscopic splenectomy in children’s with hematological diseases using ligasure regarding vascular control safety, efficacy and complications rate.Methods:A retrospective study was carried out at Queen Rania Al-Abdullah Hospital for Children over the period from January 2017 to February 2019. Total number of 18 patients with hematological diseases underwent laparoscopic splenectomy using ligasure. Demographic data, complications and outcomes were collected to assess the advantages of ligasure usage for vascular control safety.Results:Out of 18 patients underwent laparoscopic splenectomy using ligasure (10 with spherocytosis, 4 with immune thrombocytopenic purpura [ITP], 3 with sickle cell anemia, 1 with hemangioma), from which number, 8 patients were males and 10 were females. Mean age was 6.7 years (ranges from 4.3 to13.7 years). Mean operative time was 107 minutes (ranges from 70-180 minutes). There was no conversion to open splenectomy and no mortality. Intra operative blood loss was insignificant.Conclusion:Laparoscopic splenectomy using ligature is safe with excellent results in decreasing operative time, less complications and decrease incidence of intraoperative bleeding.

Laparoscopic splenectomy: Assiut University early experience

Purpose Laparoscopic splenectomy (LS) as a treatment for hematological diseases has proven its safety and efficacy with experienced surgeons. The authors present a series of LSs performed in the institution and review the experience with this approach. Patients and methods Medical records of 25 consecutive patients who underwent LS from October 2011 to March 2019 were retrospectively reviewed. Data on patient demographics, operative time, operative blood loss, hospital stay, and complications were evaluated. A comparison between the former period (group A, 2011–2015) and the latter period (2015–2019) was performed. Results The patients comprised 23 women and two men with a mean age of 35 years. The mean operative time, operative blood loss, and hospital stay were 150 min, 145 ml, and 3 days, respectively. Open conversion was performed in three (12%) patients due to intraoperative bleeding (all open conversions were in group A). Total complications occurred in three (12%) patients. A comparison between groups A and B revealed a significant shorter operative time in group B than in group A (P Conclusion LS is feasible and provides good results and safe outcomes. Further prospective studies on a larger number of patients are needed.