Laparoscopic excision of accessory spleen

BACKGROUND: Laparoscopic splenectomy has become an accepted procedure in th e management of several hematologic diseases. Less clear is the effectivene ss of laparoscopic excision of accessory spleens after initial splenectomy in the management of recurrent hematologic disease. We report here our earl y experience of this technique. METHODS: All patients who underwent laparoscopic excision of accessory sple ens (LEAS) after initial splenectomy were reviewed for preoperative studies , technical success, and effects on either platelet count or hemoglobin lev el. RESULTS: In 5 patients LEAS was attempted. Two patients had initial open sp lenectomies, and 3 had initial laparoscopic splenectomies. Hematologic diag noses were immune thrombocytopenic purpura (3), chronic lymphocytic leukemi a-induced thrombocytopenia (1), and autoimmune hemolytic anemia (1). All pa tients underwent preoperative damaged red blood cell scintigraphy, which de monstrated functioning splenic tissue, and abdominal computed tomography sc ans, which demonstrated a nodule in 4 of 5 patients. LEAS was technically s uccessful in 4 patients, with the 1 failure also being the patient in whom the computed tomography scan could not demonstrate the accessory spleen. Ho wever, only 2 of the 4 patients after LEAS had durable hematologic response s to surgery, despite follow-up damaged red blood cell scintigraphy showing no residual functioning splenic tissue. CONCLUSION: LEAS can be technically successful when the accessory spleen is demonstrated on both damaged red blood cell scintigraphy and computed tomo graphy scan; therefore, adequate visualization in both studies is required. However, hematologic response to excision may be less effective than with the initial splenectomy. Further study is needed to determine the causes of these outcomes. (C) 2000 by Excerpta Medica, Inc.