Laparoskopische splenektomie bei 26 patienten eine 17monatige verlaufsbeobachtung

Background: Laparoscopy offers a novel approach for the surgical treatment in patients requiring splenectomy. This technique was used in 26 patients and follow-up was performed at 17 months following surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure for patients requiring splenectomy. Methods: 26 patients underwent laparoscopic splenectomy for various hematologic or oncologic disorders. They were evaluated prospectively prior to, intraoperatively, following surgery, at discharge and 17 months following surgery (n = 23) to determine the short- and long-term results of laparoscopic splenectomy. Results: Mean operation time was 133.8 ± 10.7 min with no significant intraoperative complications. Mean intraoperative blood-loss was 492.3 ± 77.0 ml and autologous blood transfusion was necessary in 1 (3.8%) of all patients. Mean organ weight was 251.9 ± 38.4 g. Mean hospital stay postoperatively was 4.4 ± 0.3 days. Before discharge mean platelet count rose by 83.37% and was at follow-up (17.0 ± 1.7 months postoperativery) 67.3% above preoperative values. A significant decrease in hemoglobin was observed which, however, returned to values equal to or above preoperative values at the time of follow-up evaluation. 2 surgical revisions (7.7%) were necessary, 1 laparoscopic resection of a missed accessory spleen in a patient with idiopathic thrombocytopenic and neutrophenic (ITN) syndrome and 1 open drainage of an abscess in a patient suffering from NHL. There was no mortality associated with laparoscopic splenectomy. Long-term hematologic success was achieved in 20 (87%) out of the patients available for follow-up evaluation. Conclusions: Laparoscopic splenectomy is a safe and successful procedure in patients suffering from benign hematologic disorders which offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should, therefore, be considered in all patients requiring splenectomy for the treatment of hematologic disorders. In cancer patients, however, a careful evaluation of the suitable approach should be made.