Laparoskopische Splenektomie: Operative und hamatologische Resultate bei den ersten 35 konsekutiven Patienten

Aim of the present study: Laparoscopy offers a novel surgical approach for splenectomy. This prospective study with 35 patients requiring splenectomy examines the surgical and hematologic as well as oncologic safety of this procedure. Methods: In 35 patients (16 male, 19 female) hematologic, surgical and clinical data were obtained prospectively to evaluate the surgical and hematologic as well as oncologic safety of laparoscopic splenectomy. Long-term follow-up data are available for 23 patients at a median of 17 months postoperatively. Results: Mean operation time was 130.0 ± 8.5 minutes and despite of blood loss ≥ 1000 ml (n = 5) no significant intraoperative complications were observed. Mean blood loss was 460.0 ± 69.2 ml and blood transfusions were necessary in 3 cases (8.6%; 1 x autologous blood). Mean organ weight was 270.5 ± 34.7 g. Mean hospital stay postoperatively was 4.3 ± 0.3 days and 2 revisions were necessary (5.7%). A significant rise in platelet count from 114.8 ± 14.6 G/l to 235.0 ± 33.6 G/l was observed postoperatively which could be confirmed in long-term follow-up (213.4 ± 32.0 G/l; p < 0.05). Thrombocytopenic patients also showed this significant rise in platelet count. The initially significant fall in hemoglobin from 13.5 ± 0.4 g/dl to 10.9 ± 0.3 g/dl returned to 14.0 ± 0.4 g/dl at follow-up. Anemic patients showed a significant rise of hemoglobin at follow-up evaluation (p < 0.05). In this series of 35 consecutive patients no conversion was necessary, no mortality was observed, perioperative morbidity was 2.9% and hematologic success could be achieved in 20 (85.7%) patients available for follow-up evaluation. Conclusions: Laparoscopic splenectomy is a safe and successful surgical procedure in patients requiring splenectomy for benign hematologic diseases. This approach offers the advantages of minimal invasive surgery and should be considered in all patients requiring splenectomy.