Vergleich der laparoskopischen Splenektomie in Steinschnittlage mit der Hanging-Spleen-Technik bei idiopathischer thrombozytopenischer Purpura

Background: Laparoscopic splenectomy has become the gold standard intervention for elective splenectomy. Several techniques have been de-scribed, which differ in trocar localisations and patient positions. The hanging-spleen technique was examined in comparison to the conventional laparoscopic splenectomy in the supine position among the patient population in our institution over a period of 8 years. Patients and Methods: On the basis of a retrospective analysis, data were collected on all patients who underwent elective laparoscopic splenec-tomy for idiopathic thrombocytopenic purpura between May 1994 and April 2002 and were ex-am-ined for operation time, blood loss and peri-operative complications. Two types of operation were compared, the conventional laparoscopic splenectomy in the supine position (group A) and the hanging-spleen technique (group B). Finally, the costs of materials of the two operation techniques were compared. Results: For 51 patients (43.1 % men, 56.9 % wom-en) (mean age: 45.5 ± 17.5 years) the mean op-eration times were 134.2 ± 47.3 min (group A) and 9.8 ± 39.9 min (group B). The mean blood losses were 691.3 ± 544.4 mL in group A and 638.3 ± 1050.6 mL in group B. The perioperative com-plications were 38.8 % in group A and 21.2 % in group B. There was no significant difference found for operation time, blood loss and perioperative complications in a multivariate analysis. The cost of materials was reduced in group B (use of Endo-GIA 42.4 % in group B, 100 % in group A). In group A 4 incisions, in group B 3 incisions were necessary. Conclusions: Regarding operation time, blood loss and perioperative complications the 2 lap-a-ro-scop-ic techniques for splenectomy do not differ significantly. Merely reduced material costs and a reduction of incisions were found in patients -operated with the hanging-spleen technique. Whether the hanging-spleen technique is the method of choice will have to be shown by further prospective studies.