RESULTS OF LAPAROSCOPIC SPLENECTOMY IN SPLENOMEGALY
(Abstract release date: 05/19/16)
EHA Library. Soboleva O. 06/09/16; 134780; PB1880
Dr. Olga Soboleva
Contributions
Contributions
Abstract
Abstract: PB1880
Type: Publication Only
Background
Surgical approach to splenectomy depends on clinician’s experience and laparoscopic technique. However, splenectomy in patients with splenomegaly remains a challenge. Due to the lack of randomized controlled studies the main sources of data to evaluate surgical approach to splenomegaly are case-control series.
Aims
Our goal was to determine criteria for laparoscopic approach to splenomegaly
Methods
Since 1999 1027 patients underwent laparoscopic splenectomy (LS) at our department. Spleen size was considered to determine surgical approach in connection with other factors such as abdominal cavity volume. Splenomegaly was detected in 506 cases of 1027 LS performed. In this group the mean spleen size was 21.25 sm (range 14-34 sm), mean spleen weight was 1016 g (range 300-2650 g). The mean age was 37 years (range 14-72 years). Indications were same as for the open procedure. Mean operative time was 137 min versus 115 min in open procedure. Mean blood loss was 54 ml versus 664 ml in open procedure. Conversion rate was 19.7% (100 cases). Spleen hilum infiltration and perisplenitis were the factors most commonly leading to conversion. There were no severe complications and no deaths.
Results
Splenomegaly is not considered a crucial factor to determine surgical approach. We’ve separately analyzed 250 LS performed before 2003. Conversion rate in this group was 22 %, and it was as high as 31% in cases of splenomegaly. Since 2003 gaining experience resulted in conversion rate decrease to 18.7% in patients with splenomegaly. The conversion rate decreased with the increasing surgical experience. Apparently excessive spleen size is relevant if analyzed in proportion to limited working space in abdominal cavity. Conversion rate in lymphoproliferative disorders was 28% and for benign disorders – 13%. LS has proved to have advantages over open procedure such as minimal tissue injury, improving exposure to the superior pole and splenic pedicle and minimization of pancreatic injury. Even if excessive spleen size leads to conversion, laparoscopic approach facilitates dissection as the first operative step.
Conclusion
LS is being increasingly used in patients with splenomegaly. Spleen size is not the most important factor to determine approach to splenectomy. There is a decrease in conversion rate with the increasing surgical experience. Laparoscopic approach to splenomegaly is preferable considering sufficient knowledge and skill of the operating surgeon.
Session topic: E-poster
Keyword(s): Splenectomy
Type: Publication Only
Background
Surgical approach to splenectomy depends on clinician’s experience and laparoscopic technique. However, splenectomy in patients with splenomegaly remains a challenge. Due to the lack of randomized controlled studies the main sources of data to evaluate surgical approach to splenomegaly are case-control series.
Aims
Our goal was to determine criteria for laparoscopic approach to splenomegaly
Methods
Since 1999 1027 patients underwent laparoscopic splenectomy (LS) at our department. Spleen size was considered to determine surgical approach in connection with other factors such as abdominal cavity volume. Splenomegaly was detected in 506 cases of 1027 LS performed. In this group the mean spleen size was 21.25 sm (range 14-34 sm), mean spleen weight was 1016 g (range 300-2650 g). The mean age was 37 years (range 14-72 years). Indications were same as for the open procedure. Mean operative time was 137 min versus 115 min in open procedure. Mean blood loss was 54 ml versus 664 ml in open procedure. Conversion rate was 19.7% (100 cases). Spleen hilum infiltration and perisplenitis were the factors most commonly leading to conversion. There were no severe complications and no deaths.
Results
Splenomegaly is not considered a crucial factor to determine surgical approach. We’ve separately analyzed 250 LS performed before 2003. Conversion rate in this group was 22 %, and it was as high as 31% in cases of splenomegaly. Since 2003 gaining experience resulted in conversion rate decrease to 18.7% in patients with splenomegaly. The conversion rate decreased with the increasing surgical experience. Apparently excessive spleen size is relevant if analyzed in proportion to limited working space in abdominal cavity. Conversion rate in lymphoproliferative disorders was 28% and for benign disorders – 13%. LS has proved to have advantages over open procedure such as minimal tissue injury, improving exposure to the superior pole and splenic pedicle and minimization of pancreatic injury. Even if excessive spleen size leads to conversion, laparoscopic approach facilitates dissection as the first operative step.
Conclusion
LS is being increasingly used in patients with splenomegaly. Spleen size is not the most important factor to determine approach to splenectomy. There is a decrease in conversion rate with the increasing surgical experience. Laparoscopic approach to splenomegaly is preferable considering sufficient knowledge and skill of the operating surgeon.
Session topic: E-poster
Keyword(s): Splenectomy
Abstract: PB1880
Type: Publication Only
Background
Surgical approach to splenectomy depends on clinician’s experience and laparoscopic technique. However, splenectomy in patients with splenomegaly remains a challenge. Due to the lack of randomized controlled studies the main sources of data to evaluate surgical approach to splenomegaly are case-control series.
Aims
Our goal was to determine criteria for laparoscopic approach to splenomegaly
Methods
Since 1999 1027 patients underwent laparoscopic splenectomy (LS) at our department. Spleen size was considered to determine surgical approach in connection with other factors such as abdominal cavity volume. Splenomegaly was detected in 506 cases of 1027 LS performed. In this group the mean spleen size was 21.25 sm (range 14-34 sm), mean spleen weight was 1016 g (range 300-2650 g). The mean age was 37 years (range 14-72 years). Indications were same as for the open procedure. Mean operative time was 137 min versus 115 min in open procedure. Mean blood loss was 54 ml versus 664 ml in open procedure. Conversion rate was 19.7% (100 cases). Spleen hilum infiltration and perisplenitis were the factors most commonly leading to conversion. There were no severe complications and no deaths.
Results
Splenomegaly is not considered a crucial factor to determine surgical approach. We’ve separately analyzed 250 LS performed before 2003. Conversion rate in this group was 22 %, and it was as high as 31% in cases of splenomegaly. Since 2003 gaining experience resulted in conversion rate decrease to 18.7% in patients with splenomegaly. The conversion rate decreased with the increasing surgical experience. Apparently excessive spleen size is relevant if analyzed in proportion to limited working space in abdominal cavity. Conversion rate in lymphoproliferative disorders was 28% and for benign disorders – 13%. LS has proved to have advantages over open procedure such as minimal tissue injury, improving exposure to the superior pole and splenic pedicle and minimization of pancreatic injury. Even if excessive spleen size leads to conversion, laparoscopic approach facilitates dissection as the first operative step.
Conclusion
LS is being increasingly used in patients with splenomegaly. Spleen size is not the most important factor to determine approach to splenectomy. There is a decrease in conversion rate with the increasing surgical experience. Laparoscopic approach to splenomegaly is preferable considering sufficient knowledge and skill of the operating surgeon.
Session topic: E-poster
Keyword(s): Splenectomy
Type: Publication Only
Background
Surgical approach to splenectomy depends on clinician’s experience and laparoscopic technique. However, splenectomy in patients with splenomegaly remains a challenge. Due to the lack of randomized controlled studies the main sources of data to evaluate surgical approach to splenomegaly are case-control series.
Aims
Our goal was to determine criteria for laparoscopic approach to splenomegaly
Methods
Since 1999 1027 patients underwent laparoscopic splenectomy (LS) at our department. Spleen size was considered to determine surgical approach in connection with other factors such as abdominal cavity volume. Splenomegaly was detected in 506 cases of 1027 LS performed. In this group the mean spleen size was 21.25 sm (range 14-34 sm), mean spleen weight was 1016 g (range 300-2650 g). The mean age was 37 years (range 14-72 years). Indications were same as for the open procedure. Mean operative time was 137 min versus 115 min in open procedure. Mean blood loss was 54 ml versus 664 ml in open procedure. Conversion rate was 19.7% (100 cases). Spleen hilum infiltration and perisplenitis were the factors most commonly leading to conversion. There were no severe complications and no deaths.
Results
Splenomegaly is not considered a crucial factor to determine surgical approach. We’ve separately analyzed 250 LS performed before 2003. Conversion rate in this group was 22 %, and it was as high as 31% in cases of splenomegaly. Since 2003 gaining experience resulted in conversion rate decrease to 18.7% in patients with splenomegaly. The conversion rate decreased with the increasing surgical experience. Apparently excessive spleen size is relevant if analyzed in proportion to limited working space in abdominal cavity. Conversion rate in lymphoproliferative disorders was 28% and for benign disorders – 13%. LS has proved to have advantages over open procedure such as minimal tissue injury, improving exposure to the superior pole and splenic pedicle and minimization of pancreatic injury. Even if excessive spleen size leads to conversion, laparoscopic approach facilitates dissection as the first operative step.
Conclusion
LS is being increasingly used in patients with splenomegaly. Spleen size is not the most important factor to determine approach to splenectomy. There is a decrease in conversion rate with the increasing surgical experience. Laparoscopic approach to splenomegaly is preferable considering sufficient knowledge and skill of the operating surgeon.
Session topic: E-poster
Keyword(s): Splenectomy
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