RESIDUAL SPLENIC FUNCTION AFTER LAPAROSCOPIC SPLENECTOMY - A CLINICALCONCERN

Objective: To document the existence of residual splenic function afte r laparoscopic splenectomy in a series of 48 patients. Design: A nonco mparative descriptive case series. Setting: A tertiary care center. Pa tients: A series of 9 patients without clinical improvement after lapa roscopic splenectomy of 48 consecutive patients undergoing laparoscopi c splenectomy for several hematologic disorders after a mean follow-up of 16 months (range, 1-40 months). Interventions: A computed tomograp hic scan and technetium Tc 99m sodium pertechnetate heat-damaged red b lood cell scintigraphy were performed for patients with partial (plate let count <100X10(9)/L) or total (platelet count <50X10(9)/L) failure of improvement. Main Outcome Measure: Evidence of residual splenic tis sue by image diagnosis. Results: The condition of 9 of the 48 patients failed to improve after laparoscopic splenectomy. Six patients experi enced a total failure of improvement and 3 experienced a partial failu re of improvement (1 patient had human immunodeficiency virus-related thrombocytopenia and 8 had idiopathic thrombocytopenic purpura). Three patients had residual splenic function, which was revealed by scintig raphy. The results of a computed tomographic scan showed an accessory spleen in one patient and splenic implants in splenic fossa in another patient. Conclusion: Laparoscopic splenectomy has a promising role in the management of hematologic diseases requiring splenectomy, but it requires exquisite care to avoid parenchymal rupture and cell spillage and to avoid leaving accessory spleens, which can lead to the failure of surgical treatment.