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Laparoscopic splenectomy: experience of a single center in a series of 300 cases

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Abstract

Background

Laparoscopic splenectomy (LS) has gradually become the technique of choice for surgical removal of the spleen. The aim of this study was to evaluate the efficacy of LS in a large cohort of patients from a single center.

Methods

From March 1992 to June 2010, 300 patients underwent LS at our hospital for predominantly hematologic disorders. The first 92 cases were performed using an anterior approach, whereas in the remaining 208 cases a lateral approach with a four-trocar technique was used. Patient demographics, diagnosis, and outcomes were reviewed.

Results

Spleen volume was similar between the anterior (350 ml) and the lateral (370 ml) approaches. The lateral approach was associated with shorter operative time (60 vs. 80 min), less blood loss (30 vs. 110 ml), and no conversion (0 vs. 2.2 %) compared to the anterior approach. Reoperations were required in three patients (1.0 %) because of bleeding, subphrenic abscess, and intestinal ischemia. Postoperative complications were significantly fewer for the lateral (4.8 %) than for the anterior (31.5 %) approach and the hospital stay was shorter (3.1 vs. 5.2 days) and there was less postoperative pain. Splenectomy for hematologic malignancies resulted in a higher morbidity rate, more postoperative pain, and longer hospital stay. Overall mortality rate was 0.3 %. No late complications were observed during the 1–5-year follow-up.

Conclusions

LS using the lateral approach with the placement of four trocars can be considered the procedure of choice for both benign and malignant diseases affecting the spleen. Extensive experience and technical standardization help to avoid surgical pitfalls, providing an adequate control of hemostasis, the excision of accessory spleens (AS), and the avoidance of parenchymal rupture.

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Disclosures

Prof. F. Corcione and Drs. F. Pirozzi, G. Aragiusto, F. Galante, and A. Sciuto have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Laparoscopic and Robotic Surgery, “Azienda Ospedaliera dei Colli”—Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy

    Francesco Corcione, Felice Pirozzi, Francesco Galante & Antonio Sciuto

  2. Department of Hepatobiliary Surgery and Liver Transplantation, “A. Cardarelli” Hospital, Naples, NA, Italy

    Giuseppe Aragiusto

Authors
  1. Francesco Corcione
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  2. Felice Pirozzi
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  3. Giuseppe Aragiusto
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  4. Francesco Galante
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  5. Antonio Sciuto
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Correspondence to Francesco Corcione.

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Corcione, F., Pirozzi, F., Aragiusto, G. et al. Laparoscopic splenectomy: experience of a single center in a series of 300 cases. Surg Endosc 26, 2870–2876 (2012). https://doi.org/10.1007/s00464-012-2272-x

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  • DOI: https://doi.org/10.1007/s00464-012-2272-x

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