CONCOMITANT LAPAROSCOPIC CHOLECYSTECTOMY AND SPLENECTOMY FOR SURGICAL-MANAGEMENT OF HEREDITARY SPHEROCYTOSIS

Laparoscopic splenectomy is rapidly becoming a common treatment modali ty in the surgical management of hematological processes involving the spleen. Hereditary spherocytosis is the most common red blood cell me mbrane disorder, and its diagnosis is often associated with hemolytic crisis and premature cholelithiasis. This condition has not been succe ssfully treated laparoscopically until recently, and to our knowledge, the technique of concomitant laparoscopic splenectomy and cholecystec tomy described here is the first reported in U.S. literature. Our pati ent, a 16-year-old 5-foot 3-inch-tall 90 pound emaciated albino, prese nted with cholelithiasis, splenomegaly, and anemia. Because of persist ent anemia and gastrointestinal symptoms, the patient underwent laparo scopic cholecystectomy and splenectomy. The cholecystectomy was perfor med in a standard laparoscopic fashion. An additional 12-mm trocar was utilized for takedown of the spleen. The umbilical incision was exten ded to 4.5 cm, and the spleen was extracted manually. Total operative time was 12 hours. Examination demonstrated a 15 x 10 x 5-cm spleen, w hich weighed 350 grams. The gallbladder microscopically showed cholecy stitis and had several stones. In conclusion, we present a combined la paroscopic cholecystectomy and splenectomy for hereditary spherocytosi s associated with splenomegaly, cholelithiasis, and cholecystitis.