Laparascopic splenectomy for hematological disorders - Our experience in adult and pediatric patients

Laparoscopic splenectomy has gained increasing acceptance in the surgical m anagement of a variety of splenic disorders, in particular hematological di seases. Ln this series, we report our experience with 20 patients (male:fem ale ratio of 4:16 with median age of 16 years, range 5-49 Sears) who underw ent this procedure because of ITP in 9 cases, spherocytosis in 7 and Cooley disease, sickle cell anemia, dyserythropoietic and hemolytic anemia in one case each. The patient was placed in a supine position using a four-trocar s technique. We did not perform pre-operative splenic artery embolization i n any case. Spleen lower pole and its posterolateral attachments were disse cted first, using electrocautery and endoclips, Vascular hilar isolation was achieved with an EndoGIA stapler and the splee n was removed by morcelation within a retrieval bag (16 cases) or via a 4-5 cm left subcostal incision (4 cases). One patient required conversion to open technique (conversion rate 5%), bec ause of uncontrolled bleeding from splenic hilum, Mean operative time was 165 min (range 100-240 min), mean splenic size was 13.5 cm (range 11-20 cm), with weight ranging between 140 and 1060 g and es timated blood loss was 151 mi (75-280 mi), No patient required a blood tran sfusion. Median postoperative hospital stay was 4 days (range 3-8 days), Postoperative complications occurred in 2 patients (10%), with no mortality rate in this series. Regarding the low complication rate and the advantages of a small abdominal trauma in the postoperative period, such as less postoperative pain, faste r hospital discharge and better cosmetic results, the laparoscopic approach for elective splenectomy in hematological disorders has a substantial bene fit for the patient.