Laparoskopische Splenektomie

Laparoscopic splenectomy was first described in 1991 and has become an attractive surgical alternative to the open procedure for patients requiring splenectomy. A number of surgical centers perform this procedure routinely. Between May 1994 and May 2001 a total of 74 patients (37 males, 37 females) underwent laparoscopic splenectomy. Mean patient age was 46±2 years. In 46 patients (62%) splenectomy was done for the treatment of idiopathic thrombocytopenic purpura (ITP; Werlhof's disease). Mean length of surgery was 113±6 minutes with a significant decrease over time (cases 1-10: 163±15 min, cases 64-74: 79±8 min; p <0,05). Mean weight of the removed organs was 378±79 g. During the perioperative course 9 patients (12%) developed relevant complications (6 intraoperative blood losses > 1000 ml, 1 postoperative hemorrhage, 1 hematothorax, 1 seropneumothorax. Mean intraoperative blood loss was 489±98 ml (0-3500 ml). In 10 patients (14%) a total of 11 accessory spleens were removed within the laparoscopic procedure. The postoperative in-hospital stay was 4±0,2 days. In 2 patients recurrent disease developed due to missed accessory spleens (ITP, Non-Hodgkin-Lymphoma) and additional surgery was required. One patient suffered from a trocar hernia that required surgical revision. Laparoscopic splenectomy is a safe and hematological successful procedure. The data published so far as well as our findings demonstrate the surgical effectiveness of this procedure. Until laparoscopic splenectomy can be termed gold-standard additional studies are required to evaluate all indications and possible contraindications of this therapeutic option. Experienced surgical centers should offer laparoscopic surgery as a routine procedure to evaluate this therapeutic option and to warrant the necessary surgical education.