Impact of hematological diagnosis on early and late outcome after laparoscopic splenectomyrid="" |
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Authors: | M Trias E M Targarona J J Espert G Cerdan E Bombuy O Vidal V Artigas |
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Institution: | (1) Service of General and Digestive Surgery, Hospital de S. Pau, Autonomous University of Barcelona, C/P Claret 167, 08025 Barcelona, Spain, ES;(2) Service of General and Digestive Surgery, Hospital Clinic, C/P Claret 167, 08025 Barcelona, Spain, ES |
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Abstract: | Background: Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there
have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions
associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome
after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed
a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS
patients.
Methods: We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by
hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided
into group 1A, idiopathic thrombocytopenic purpura (ITP) (n= 48) and group 1B, HIV-related ITP (n= 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n= 8), and group 2B, spherocytosis (n= 11); (c) group 3, malignancy (n= 28); and (d) group 4, others (n= 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean
follow-up of 24 ± 18 months.
Results: There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity,
although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups
3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in ≥75% of patients (group 1A,
82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality
was 6.2%, mainly due to deaths in group 4 (six of 22 patients).
Conclusion: LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases
and a long-term hematological response comparable to the standard results that have been observed in open series.
Received: 1 April 1999/Accepted: 22 November 1999/Online publication: 8 May 2000 |
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Keywords: | : Anemia — Autoimmune thrombopenia — Hematological disease — Laparoscopic splenectomy — Splenectomy — Splenomegaly |
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