LAPAROSCOPIC SPLENECTOMY; SINGLE SURGEON, SINGLE CENTRE INITIAL EXPERIENCE AT TERTIARY LEVEL HOSPITAL IN PESHAWAR
AbstractBackground: Despite the fact that Laparoscopic splenectomy has become first choice for most cases of splenectomy in the developed world, open splenectomy is still being done in majority of the developing countries. There is no local data of our hospital on laparoscopic splenectomy. Methods: Cross sectional study of 103 patients with laparoscopic splenectomy from Feb, 2013 to Jan, 2018 done for benign conditions of spleen at Khyber Teaching Hospital, Peshawar. Consecutive non-probability sampling was done. Lateral approach was utilized. Patients’ demographics, preoperative characteristics and intra / postoperative complications were collected on a proforma. Results: Mean age was (26) years. Two third (2/3) of patients were female. Major indication was ITP (Idiopathic Thrombocytopenic Purpura) followed by HS (Hereditary Spherocytosis). Total splenectomy was done in splenic cysts. In half of the cases, platelet and / or blood were transfused preoperatively as a measure of preoperative optimization. Intraoperative & postoperative complications occurred in (8%) which were managed conservatively. Conversion rate was (0%). Triple vaccination was done in almost all patients. Conclusion: Laparoscopic splenectomy is safe in experienced hands and should be the first choice in elective cases even in developing world. Local surgeons should train residents and junior surgeons to improve laparoscopic skills as training abroad is costly.
Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review. In Vivo 2017;31(3):291–302.
Bai YN, Jiang H, Prasoon P. A meta-analysis of perioperative outcomes of laparoscopic splenectomy for hematological disorders. World J Surg 2012;36(10):2349–58.
Machado NO, Grant CS, Alkindi S, Daar S, Al-Kindy N, Al Lamki Z, et al. Splenectomy for haematological disorders: A single center study in 150 patientsfrom Oman. Int J Surg 2009;7:476–81.
Vecchio R, Cacciola E, Lipari G, Privitera V, Polino C, Cacciola R. Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura. JSLS 2005;9(4):415–8.
Orcalli F, Elio A, Veronese E, Frigo F, Salvato S, Residori C. Conservative laparoscopy in the treatment of posttraumatic splenic laceration using microfiber hemostatic collagen: three case histories. Surg Laparosc Endosc 1998;8:445–8.
Ermolov AS, Tlibekova MA, Yartsev PA, Guliaev AA, Rogal MM, Samsonov VT, et al. Laparoscopic Splenectomy in Patients with Spleen Injuries. Surg Laparosc Endosc Percutan Tech 2015;25(6):483–6.
Vianelli N, Palandri F, Polverelli N, Stasi R, Joelsson J, Johansson E, et al. Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years. Haematologica 2013;98(6):875–80.
Liu EH, Dilip CK, Yeh TS, Wu JH, Jan YY, Chen MF. Long-term relapse-free rurvival rate and predictive factors of idiopathic thrombocytopenic purpura in adults undergoing splenectomy. Biomed J 2013;36(1):23–7.
Rehmani B, Kumar N, Pathak P. Changing trends in elective splenectomy at a tertiary hospital in North India-a 10year study. Int Surg J 2017;4(8):2589–93.
Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 2003;238(2):235.
Zhang GY, Hu SY, Zhang HF, Wang KX, Wang L. A novel therapeutic approach to non-parasitic splenic cysts: laparoscopic fenestration and endothelial obliterations. Minim Invasive Ther Allied Technol 2007;16(5):314–6.
Geraghty M, Khan IZ, Conlon KC. Large splenic cyst: a laparoscopic technique. J Minim Access Surg 2009;5(1):14–6.
Wang Y, Zhan X, Zhu Y, Xie Z, Zhu J, Ye Z. Laparoscopic splenectomy in portal hypertension: a single-surgeon 13-year experience. Surg Endosc 2010;24(5):1164–9.
Casaccia M, Torelli P, Pasa A, Sormani MP, Rossi E. Putative predictive parameters for the outcome of laparoscopic splenectomy: a multicenter analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen. Ann Surg 2010;251(2):287–91.
Chen X, Peng B, Cai Y, Zhou J, Wang Y, Wu Z, et al. Laparoscopic splenectomy for patients with immune thrombocytopenia and very low platelet count: Is platelet transfusion necessary? J Surg Res 2011;170(2):e225–32.
Wu Z, Zhou J, Li J, Zhu Y, Peng B. The feasibility of laparoscopic splenectomy for ITP patients without preoperative platelet transfusion. Hepatogastroenterology 2012;59(113):81–5.
Cai Y, Liu X, Peng B. Should we routinely transfuse platelet for immune thrombocytopenia patients with platelet count less than 10× 109/L who underwent laparoscopic splenectomy? World J Surg 2014;38(9):2267–72.
Corcione F, Pirozzi F, Aragiusto G, Galante F, Sciuto A. Laparoscopic splenectomy: Experience of a single center in a series of 300 cases. Surg Endosc 2012;26(10):2870–6.
Fraser SA, Bergman S, Garzon J. Laparoscopic splenectomy: Learning curve comparison between benign and malignant disease. Surg Innov 2012;19(1):27–32.
Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 2004;104(9):2623–34.