Laparoscopic Total Splenectomy Research Articles

Minimally invasive splenectomy is associated with a low perioperative complication rate and short operative time in cats.

To report the perioperative outcome and complications in cats undergoing minimally invasive splenectomy. 17 client-owned cats. Perioperative data were collected from cats undergoing minimally invasive splenectomy from September 2010 to June 2023. Data included history, signalment, preoperative examination and diagnostic testing results, operative technique and time, perioperative outcomes, complications, hospitalization duration, histopathological diagnosis, and outcome. 13 spayed females and 4 neutered males were included, with a median age of 144 months (48 to 196 months). Seven cats underwent total laparoscopic splenectomy (TLS), with 1 cat requiring conversion from TLS to laparoscopic-assisted splenectomy (LAS) due to splenomegaly and an additional cat requiring conversion from TLS to open splenectomy due to uncontrollable splenic capsular hemorrhage. Ten cats underwent LAS, with 1 cat requiring conversion to open splenectomy due to splenomegaly. Additional procedures were performed in 13 cats, with the most common being liver biopsy in 10 cats. Median operative times were 50 minutes (45 to 90 minutes) for TLS and 35 minutes (25 to 80 minutes) for LAS. An intraoperative complication occurred in 1 cat. All but 1 cat survived to discharge. Median follow-up time was 234 days (18 to 1,761 days), with 15 of 16 cats confirmed alive at 30 days and 9 of 16 cats alive at 180 days postoperatively. Minimally invasive splenectomy in this cohort of cats was associated with short operative times and a low perioperative complication rate. Veterinary surgeons may consider minimally invasive splenectomy as an efficient and feasible technique in the treatment of splenomegaly or modestly sized splenic masses for diagnostic and therapeutic purposes in cats.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function.

The liver hemodynamic changes caused by portal hypertension (PH) are closely related to various complications such as gastroesophageal varices and portosys-temic shunts, which may lead to adverse clinical outcomes in these patients, so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications. To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function. Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups. The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences. TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.

Laparoscopic management of benign splenic tumors in children

BackgroundThe splenic tumor is relatively rare in children. However, diagnosing and managing this disease remain controversial. This study aimed to evaluate the clinical characteristics and pathological features of benign splenic...

Effectiveness of Articulating Linear Stapler for Total and Partial Laparoscopic Splenectomy in Children.

Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.

Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases.

Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.

Isolated metachronous splenic multiple metastases after colon cancer surgery: A case report and literature review

BACKGROUNDIsolated splenic metastasis is a rare clinical entity. Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare.CASE SUMMARYWe report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously, and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen (CEA) and positron emission tomography (PET). However, multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging. Then the patient underwent total laparoscopic splenectomy. Local tumor recurrence and splenic metastasis from colorectal cancer (CRC) were found by postoperative pathology. Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2, APC exon16 and TP53 exon6 missense mutations, but no mutations of NRAS, KRAF, EGFR, ERBB2, MET, MLH1, MSH2 and MSH6 were detected. Chemotherapy and target therapy were administered after multiple disciplinary team (MDT) consultation, and no tumor recurrence has been observed to date. We also reviewed the literature by conducting a search of the PubMed database using the following key words: CRC, splenic metastasis, isolated, and review. We identified 34 relevant papers, which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis.CONCLUSIONClose monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery. In terms of overall survival and progression-free survival, MDT plays an important role in the entire process of disease management.

Acute Chest Syndrome After Splenectomy in Children With Sickle Cell Disease

BackgroundIndividuals with sickle cell disease (SCD) are at high risk of developing life-threatening complications, particularly acute chest syndrome (ACS) postoperatively. The perioperative factors associated with the development of ACS in children with SCD after splenectomy have not been clearly identified. Materials and methodsWe retrospectively reviewed medical records of all children who underwent splenectomy at our institution between 1997 and 2017 with the goal of identifying perioperative factors associated with postoperative ACS. Categorical and noncategorical variables were compared using Fisher’s exact test and Student's two-tailed t-test, respectively. ResultsSixty-five patients with SCD underwent splenectomy at a median of 4.0 (interquartile range [IQR] 2.0-8.0) years of age. A laparoscopic approach was used for 64 (98.5%) patients. Fifty-six (86.2%) underwent laparoscopic total splenectomy, and eight (12.3%) underwent laparoscopic partial splenectomy, of which two were converted to open. One had an open partial splenectomy (1.5%). Of the 65 patients, 10 (15.4%) developed ACS with a mean time to diagnosis of 49.0 ± 34.5 h. Children who developed ACS had a higher postoperative median pain score of 6.8 (IQR 5.1-9.1) versus 2.7 (IQR 1.6-4.2), P < 0.001, higher median pain score area under the curve 111.5 (IQR 76.9-169.1) versus 47.3 (IQR 30.5-78.3), P = 0.01, and received more total morphine equivalents (median 1.4 [IQR 0.4-2.7] versus 0.5 [IQR 0.3-0.9] mg/kg, respectively; P = 0.003), compared with children who did not develop ACS. ConclusionsSignificant postoperative pain may be an early sign of ACS that could be worsened by opioid use, supporting the investigation of nonopioid pain control options in this patient population.

Feasibility and Safety of Laparoscopic Partial Splenectomy: A Systematic Review.

Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits. We conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles. A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225min and 0-1200ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1-11days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.4 ± 1.8days, LPS 4.2 ± 0.8days, p = 0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p = 0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p = 0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume. In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.

The effect of laparoscopic partial splenectomy for spleen benign lesions

Introduction: To confirm the value of laparoscopic partial splenectomy (LPS) in the surgical therapy of spleen benign lesions. Methods: A total of 22 patents with splenic benign lesions undergone laparoscopic splenectomy in Zhejiang University Huzhou Hospital from Sep 1 2016 to Aug 31 2017 were analyzed retrospectily. Results: Depending on the result of the preoperative imaging evaluation of the lesion's location and the future splenic volume, 7 patients were undergone laparoscopic total splenectomy (LTS) and 15 patients undergone LPS successfully without conversion to open splenectomy or LTS respectively . There is no statistic difference in operating time, intra-operative blood loss and transfusion between the two groups. However, the morbidity of LPS group was significant lower (p = 0.0012), and no thrombocytosis occurred in LPS patients. Additionally, the patients received LPS recovered quickly and the postoperative hospital stay was significant shorter (5.7 ± 2.3 vs. 15.3 ± 3.4 days, p = 0.0001) with a lower medical expenditure (19288 ± 2760 vs. 27737 ± 4626 ¥, p = 0.0013). No thrombocytosis and recurrence were observed during follow up in all 22 patients. Conclusions: According with the idea of enhanced recovery after surgery (ERAS) , LPS is safe and effective surgical therapy to preserve the function of spleen for selected patient with spleen benign lesions. Keywords: Laparoscope, partial splenectomy, spleen benign lesion, spleen preservation, postoperative outcome

Operative and Immediate Postoperative Differences Between Traditional Multiport and Reduced Port Laparoscopic Total Splenectomy in Pediatric Patients.

Laparoscopy offers many benefits to splenectomy, such as reduced incisional pain and shortened hospital duration. The purpose of this study is to evaluate procedural and outcome differences between multiport (MP) and reduced port (RP) splenectomy when utilized to treat children. An institutional review board approved retrospective analysis of all consecutive laparoscopic total splenectomies performed at a single institution between January 2010 and October 2015 was conducted. We evaluated demographics, surgical technique, instance of conversion, operative duration, estimated blood loss, need for intraoperative blood transfusion, postoperative length of stay, time to full feeds, complications, and follow-up duration. Over a 5-year period, 66 patients less than 20 years of age underwent laparoscopic total splenectomy. RP splenectomy was attempted in 14 patients. The remaining 52 were MP operations. Populations were comparable with regard to demographics. Preoperative splenic volumes (mL) were greater in the RP population (median [IQR]: 1377 [747-1508] versus 452 [242-710], P = .039). RP splenectomy demonstrated no difference compared to MP splenectomy in operative time (153 versus 138 minutes, P = .360), estimated blood loss (120 versus 154 mL, P = .634), or percent of cases requiring intraoperative blood transfusion (14 versus 23, P = .716). By the first postoperative day, 57% of RP and 17% of MP patients could be discharged (P = .005). Thirty-day readmission rates were similar, at 7% for RP and 8% for MP operations. Fever was the indication for all readmissions. Mean duration of follow-up is 28 months for MP and 13 months for RP cases. A reduced number of ports can be safely utilized for total splenectomy in pediatric patients without increasing procedural duration or need for intraoperative blood transfusion. In addition, rate of discharge on the first postoperative day was significantly higher in the RP splenectomy group.

Clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization

Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 64 patients who underwent laparoscopic splenectomy combined with pericardial devascularization at the Second Affiliated Hospital of Kunming Medical University from April 2012 to June 2015 were collected. Observed indexes included (1) treatment outcomes, including surgical procedures, operation time, volume of intraoperative blood loss, time of postoperative enteral recovery, time of postoperative drainage tube removal, duration of postoperative hospital stay, occurrence of complications, (2)follow-up situation. The follow-up using reexaminations of blood routine, liver function, coagulation function, gastroscopy and color Doppler ultrasonography of portal vein was performed regularly at postoperative month 1, 2, 3, 6, 12, 24 until reemergence of gastrointestinal hemorrhage. The final deadline was death of patients and performance of liver transplantation. Measurement data with normal distribution were presented as ±s. Results (1) Treatment outcomes: of 64 patients, 62 underwent total laparoscopic splenectomy combined with pericardial devascularization successfully. One patient was transffered to hand-assisted laparoscopic splenectomy combined with pericardial devascularization due to uncontrollable hemorrhage. One patient received laparoscopic cholecystectomy firstly with volume of blood loss of about 1 500 mL and terminated surgery after infusion of suspension red blood cells of 6 U and plasma of 900 mL, and underwent laparoscopic splenectomy combined with pericardial devascularization again next week. No postoperative hemorrhage, pancreatic leakage or death occurred during the perioperative period. The operation time, volume of intraoperative blood loss, time of postoperative enteral recovery, time of postoperative drainage tube removal and duration of postoperative hospital stay were (146±33)minutes, (214±31)mL, (24±4)hours, 7 days and (14±6)days, respectively. Nine patients had postoperative pleural effusion and recovered after thoracic drainage and thoracentesis. (2) Follow-up situation: All the 64 patients were followed up for an average time of 19.7 months (range, 3.0-23.0 months). Reexamination of gastroscopy showed improvement of varicosed veins of lower esophagus and fundus of stomach. During the postoperative 3 months, 4 patients had portal vein thrombosis with level of PLT>700×109/L. For patients with D-Dimer>5, low molecular weight heparin of 0.4 U was injected subcutaneously until D-Dimer<2. Three patients were loss to follow-up at postoperative month 6 without upper gastrointestinal hemorrhage, hepatic encephalopathy or liver failure. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is safe and effective for portal hypertension, and rigorous perioperative management offers guarantee for surgical safety. Key words: Portal hypertension; Splenectomy; Pericardia devascularization; Laparoscopy

A Case of Splenic Metastasis of Ovarian Cancer Treated with Complete Laparoscopic Splenectomy and Transvaginal Specimen Extraction

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised and an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

Laparoscopic splenectomy for hereditary spherocytosis-preliminary report.

Splenectomy is considered standard surgical therapy in hereditary spherocytosis. The procedure is indicated in patients with severe anemia, recurrent hemolytic, and aplastic crises. The aim of the study was to assess treatment outcomes in patients with hereditary spherocytosis who underwent total or partial laparoscopic splenectomy. Fifteen patients aged 4-17 yr underwent laparoscopic splenectomy from 2009 to 2012. Partial and total splenectomies were performed (five and 10 children, respectively). Hematologic parameters, liver function tests, and splenic volume before and after the surgery were analyzed retrospectively. Total follow-up was 1-30 months. Hospitalization and operating time were similar in both groups. In partial splenectomy group, branches of splenic arteries gave better blood supply than short gastric vessels. In both groups, hematologic parameters were improved. Postoperative markedly elevated platelet count was maintained up to 6 months, and after that, platelet count gradually decreased to normal values. Bilirubin level was decreased in early postoperative period; however, it increased later to achieve levels lower than in preoperative period. No severe general infections were observed in both groups. Laboratory parameters (hemoglobin and bilirubin concentrations and RBC) after the surgery improved in all patients, and the effect was maintained during 12 months of follow-up. Platelet count increased significantly after the surgery and was maintained at high levels during the next 6 months. However, it returned to preoperative levels within a year after the surgery. Our study showed that partial splenectomy was not inferior to total splenectomy. However, full assessment requires longer follow-up and larger group of patients.

Role of Laparoscopic Partial Splenectomy for Tumorous Lesions of the Spleen

BackgroundLaparoscopic partial splenectomy (LPS) is a surgical option for splenic masses, with the goal of reducing postoperative complications while preserving splenic function. MethodsThirty-seven patients who underwent laparoscopic splenectomy for tumorous lesions of the spleen at two affiliated hospitals were enrolled. Among them, 22 patients underwent laparoscopic total splenectomy (LTS) and 15 patients underwent LPS. ResultsThe tumorous lesions of the spleen in both groups, in order of decreasing frequency, consisted of epithelial cysts, hemangiomas, lymphangiomas, abscesses, metastatic tumors, and hamartomas. All procedures were completed by laparoscopy, and the pathologic lesions in the spleen were completely removed in both groups. There were no significant differences between the groups in terms of the operative time (LTS 151.5±98.5 min, LPS 168.6±46.8 min, p = 0.483), intraoperative blood loss (LTS 337.3±188.4 ml, LPS 422.6±187.4 ml, p = 0.185), and transfusion rate (LTS 3/22 [13.6 %], LPS 3/15 [20.0 %], p = 0.606). However, there were significant differences in postoperative complications such as pleural effusion (LTS 9/22 [40.9 %], LPS 0/15 [0 %], p = 0.005), splenic vein thrombosis (LTS 10/22 [45.5 %], LPS 0/15 [0 %], p = 0.002), and postoperative hospital stay (LTS 5.4±1.8 days, LPS 4.2±0.8 days, p = 0.027). ConclusionsLPS is a feasible, safe surgical procedure in patients with tumorous lesions of the spleen, and it represents an effective approach to reduce postoperative hospital stay and complications.

Analysis of postoperative complications and risk factors in patients with portal hypertension treated by laparoscopic splenectomy

Objective To investigate the postoperative complications after laparoscopic splenectomy for patients with portal hypertension,and analyze the risk factors for postoperative complications.Methods The clinical data of 65 patients with portal hypertension who received laparoscopic splenectomy at the West China Hospital from September 2003 to September 2012 were retrospectively analyzed.The postoperative complications were analyzed using the modified Clavien classification system,and the risk factors for postoperative complications were analyzed.The measurement data and the count data were analyzed using the t test,chi-square test or the Fisher exact probability.The univariate and multivariate analysis were done using the Logistic regression model.Results Twenty-nine patients received hand-assisted laparoscopic splenectomy and 36 received total laparoscopic splenectomy (2 patients were converted to open surgery due to intraoperative bleeding).Sixteen patients had 20 complications.The incidence of postoperative complications of the hand-assisted laparoscopic group was 10.3％ (3/29),which was significantly lower than 38.2％ (13/34) of the total laparoscopic group (x2 =3.90,P ＜ 0.05).According to the modified Clavien classification system,there were 4 patients with grade Ⅰ complication,2 patients with grade Ⅱ complication,8 patients with grade Ⅲ a complication,1 with grade Ⅲ b complication,1 with grade Ⅳa complication,and no Ⅳb or Ⅴ complication was observed.The duration of postoperative hospital stay was (8.4 ± 2.9) days.For patients with grade Ⅱ,Ⅲ and Ⅳ complications,the duration of postoperative hospital stay was (10.1 ± 3.3) days,which was significantly longer than (7.7 ± 2.5) days of patients with grade Ⅰ complication or without complications (t =4.30,P ＜ 0.05).The results of univariate analysis showed that ASA classification and application of hand-associated device were risk factors for postoperative complications (x2=21.60,5.10,P ＜0.05).The results of multivariate analysis showed that ASA grade Ⅲ and non-application of hand-assisted device were independent risk factors for postoperative complications (OR =23.60,4.60,P ＜ 0.05).The incidence of postoperative complications of patients with ASA grade Ⅲ were 17.00 times higher than patients with ASA grade Ⅱ,and the incidence of postoperative complications of patients who received total laparoscopic splenectomy was 5.00 times higher than those who received hand-assisted laparoscopic splenectomy.Conclusions The incidence of postoperative complications is higher in patients with portal hypertension,while the severity of the complications is under ASA grade Ⅲ.ASA classification and application of hand-assisted device are correlated with the incidence of postoperative complications. Key words: Portal hypertension ;  Laparoscopy ;  Splenectomy ;  Complications

Partial versus total splenectomy in children with hereditary spherocytosis

Partial splenectomy is utilized selectively in children with hereditary spherocytosis (HS) to decrease hemolysis while maintaining immunity. Our aim was to compare outcomes between laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS). After obtaining institutional review board approval, we reviewed the records for all children ≤18 years with HS undergoing LTS and LPS between 2002 and 2012. Wilcoxon rank-sum tests were used. Eighty-seven HS children underwent LTS (n = 71) and LPS (n = 16). Mean age was 7.1 ± 3.6 years (LTS) and 5.5 ± 2.8 years (LPS; P = .14). Concomitant cholecystectomy was performed in 32% ofLTS and 38% of LPS cases. Operative time was 87 ± 33 minutes (LTS) and 140 ± 36 minutes (LPS;P = .0005). Duration of stay was 1.2 ± 0.5 days (LTS) and 2.4 ± 1.4 days (LPS; P = .003). Reticulocyte and hemoglobin levels improved after both operations. LPS children had lower preoperative (8.8 ± 1.9 vs 10.2 ± 1.7 g/dL; P = .0148) and postoperative (10.5 ± 1.7 vs 13.8 ± 1.1 g/dL; P<.0001) hemoglobin levels than did LTS patients. Three LPS children required transfusion (at2,4and 5 postoperative years) for parvovirus-associated aplastic crises. No LTS child developed splenic function or anemia. These data demonstrate that LPS decreases hemolysis, although LTS is more effective. LPS children had lower preoperative hemoglobin levels, indicating more severe hemolysis. LPS also has greateroperative time and duration of stay, disadvantages balanced by retained immunity.

Laparoscopic splenectomy: a surgeon’s experience of 302 patients with analysis of postoperative complications

This study aimed to evaluate the operative and clinical outcomes in a series of 302 consecutive laparoscopic splenectomies and to analyze the risk factors of postoperative complications. The study retrospectively reviewed 302 consecutive patients who underwent laparoscopic splenectomy. The patients were classified into three disease groups: benign spleen-related disease (group 1, n=196), malignant spleen-related disease (group 2, n=42), and portal hypertension (group 3, n=64). The three groups were compared in terms of perioperative data. Postoperative complications were classified into three complication groups according to the Clavien-Dindo Classification of Surgical Complications and Severity: no complication, mild complications, and severe complications. Multivariate logistic regression was used to analyze the independent risk factors of postoperative complications. The patients in group 1 were younger and had a higher body mass index, a lower American Society of Anesthesiology (ASA) score, and a smaller spleen than the patients in groups 2 and 3. Fewer patients in group 1 required hand-port assistance than in the other two groups. Group 1 had shorter operative times, required fewer transfusions, presented a lower incidence of complications, and had shorter postoperative stays than groups 2 and 3. In the analysis of complications, high ASA score was an independent risk factor for the occurrence of complications. Both high ASA score and larger spleen size were independent risk factors for the occurrence of severe complications. Compared with total laparoscopic splenectomy, the data including the hand-assisted cases showed a reduction in odds ratio for both the occurrence of complications and the occurrence of severe complications. The treatment of malignant spleen-related disease and portal hypertension with laparoscopic splenectomy is more challenging than the treatment of benign disease. High ASA score is an independent risk factor for the occurrence of complications, whereas high ASA score and larger spleen size are both independent risk factors for the occurrence of severe complications. The appropriate introduction of the hand-assisted technique may facilitate the laparoscopic procedure and reduce postoperative complications.

Laparoscopic distal pancreatectomy: A Sri Lankan experience

Distal pancreatectomy is the surgical procedure indicated for pathology in the body or tail of the pancreas.Though laparoscopic distal-pancreatectomy for benign conditions was first described in the early 1990s, there are no reported cases in Sri Lanka.We report a female of twenty four years who was diagnosed to have a mass in the tail of the pancreas. She underwent a total laparoscopic distal pancreatectomy and splenectomy. Five ports were used. The procedure was completed in 150 minutes without a measurable blood loss. The specimen was retrieved via a 5 cm incision. She was discharged on the fourth post operative day. Histopathology revealed a solid pseudopapillary tumour. DOI: http://dx.doi.org/10.4038/sljs.v31i1.5491 The Sri Lanka Journal of Surgery 2013; 31(1):22-23

Giant Epidermoid Cyst of the Spleen with Elevated CA 19-9 Production Managed Laparoscopically: Report of a Case

True splenic cysts are uncommon and are associated with elevated serum and intracystic tumor marker CA 19-9 levels. A 33-year-old woman presented to our hospital with a chief complaint of epigastralgia. Computed tomography of the abdomen showed a 10-cm cystic lesion in the spleen. The serum carbohydrate antigen (CA) 19-9 level was 3,347 U/mL (normal, <37 U/mL). Total laparoscopic splenectomy was performed, and the serum level of CA 19-9 had normalized 2 weeks later. Pathological examination showed a benign true epidermal cyst of the spleen with strong immunohistological staining for CA 19-9. Splenic epidermoid cysts most often occur in young women, and laparoscopic surgery to remove cysts of this type is minimally invasive. Thus, laparoscopic surgery should be the method of first choice for most cases of splenic benign true cyst.