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Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

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Abstract

Aim

The preoperative detection of accessory spleen (AS) is still a very important and serious problem. The aim of the study was to assess the reasons for failure and the long-term results of laparoscopic splenectomy (LS) in patients with idiopathic thrombocytopenic purpura (ITP).

Method

Fifty-eight ITP patients underwent LS between June 1998 and December 2002. There were 42 women and 16 men. Preoperatively, we performed computed tomography (CT) and sonography to evaluate the size of the spleen and possibly to recognize the presence of the accessory spleens, which were found preoperatively in three cases.

Results

Intraoperatively, ASs were found in the course of laparoscopy in six cases overall, three preoperatively false negative. During follow-up (median time 31 months), in three patients the low platelet count was recognized, respectively after 5 months and 1.5 and 1.8 years. In all those cases scintigraphy was performed and in one case the residual accessory spleen, missed both in preoperative examination and during laparoscopy, was revealed. In two other patients, in spite of thrombocytopenia, no residual spleens were found.

Conclusion

We conclude that the problem of accessory spleens can be managed by careful videoscopic examination of the abdominal cavity during splenectomy, while the use of preoperative imaging techniques in detection of accessory spleens is still limited by the insufficient sensitivity of the examination.

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Authors and Affiliations

  1. Department of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdansk, 1 Prof. Kieturakis Street, 80-742, Gdansk, Poland

    Aleksander Stanek, Tomasz Stefaniak, Wojciech Makarewicz, Łukasz Kaska & Andrzej Lachinski

  2. Department of Radiology, Institute of Marine and Tropical Medicine, Gdynia, Poland

    Hanna Podgórczyk

  3. Department of Haematology, Medical University of Gdansk, Gdansk, Poland

    Andrzej Hellman

Authors
  1. Aleksander Stanek
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  2. Tomasz Stefaniak
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  3. Wojciech Makarewicz
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  4. Łukasz Kaska
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  5. Hanna Podgórczyk
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  6. Andrzej Hellman
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  7. Andrzej Lachinski
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Correspondence to Tomasz Stefaniak.

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Stanek, A., Stefaniak, T., Makarewicz, W. et al. Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients. Langenbecks Arch Surg 390, 47–51 (2005). https://doi.org/10.1007/s00423-003-0449-4

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  • DOI: https://doi.org/10.1007/s00423-003-0449-4

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