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Laparoscopic subtotal splenectomy in hereditary spherocytosis

To preserve the upper or the lower pole of the spleen?

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Abstract

Background

Clinical manifestations of hereditary spherocytosis can be controlled by splenectomy. The use of this procedure has been restricted due to concerns regarding exposure of patients to a lifelong risk of overwhelming infections. Subtotal splenectomy, which removes 85–90% of the enlarged spleen, is a logical alternative. In the first cases performed by laparoscopy we have chosen to preserve the upper pole. However, this technique showed some disadvantages, especially concerning the correct intraoperative evaluation of the splenic remnant volume. Therefore, we developed a new variant of the procedure by preserving the lower pole of the spleen.

Methods

Based on the authors’ experience in laparoscopy (176 laparoscopic splenectomies), 10 laparoscopic subtotal splenectomies were performed in patients with hereditary microspherocytosis, preserving either the upper or the lower splenic pole.

Results

Patient age ranged between 5 and 35 years. The mean volume of the remnant spleen was 41.4 cm3. There were no complications, and no transfusions were needed. Follow-up for 1–30 months was available.

Conclusions

Subtotal splenectomy appears to control hemolysis while maintaining splenic function. The laparoscopic approach is safe and effective and should be considered the procedure of choice in hereditary microspherocytosis. Laparoscopic subtotal splenectomy presents an advantage over open subtotal splenectomy, resulting in decreased blood loss, shorter hospital stay, no conversions, fewer operative and postoperative complications, and excellent remission rates. On the basis of our experience, the preservation of the lower pole of the spleen seems to be a first-line option for the optimal evaluation of the residual splenic mass.

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Acknowledgment

We thank Leslie Cizmas, Ph.D., Texas A&M University.

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Authors and Affiliations

  1. Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania, RO-72434

    C. Vasilescu, O. Stanciulea & S. Tudor

  2. Department of Nuclear Medicine and Ultrasounds, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania, RO-72434

    D. Stanescu

  3. Department of Hematology, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania, RO-72434

    A. Colita, R. Stoia & D. Coriu

  4. Department of Pediatrics, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania, RO-72434

    A. Colita & C. Arion

Authors
  1. C. Vasilescu
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  2. O. Stanciulea
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  3. S. Tudor
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  4. D. Stanescu
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  5. A. Colita
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  6. R. Stoia
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  7. D. Coriu
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  8. A. Colita
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  9. C. Arion
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Corresponding author

Correspondence to C. Vasilescu.

Additional information

The paper is based on material presented at the 13th International Congress of the European Association for Endoscopic Surgery (EAES), Venice, 2005

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Vasilescu, C., Stanciulea, O., Tudor, S. et al. Laparoscopic subtotal splenectomy in hereditary spherocytosis. Surg Endosc 20, 748–752 (2006). https://doi.org/10.1007/s00464-005-0429-6

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  • DOI: https://doi.org/10.1007/s00464-005-0429-6

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