Author(s): Balagu C, Targarona EM, Cerdn G, Novell J, Montero O,
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Abstract BACKGROUND: Laparoscopic splenectomy (LS) has been demonstrated as an effective and safe treatment for hematological disorders requiring spleen removal, especially in cases of normal-sized spleens. However, although results are promising, long-term outcome data are lacking. We reviewed our clinical experience with LS in a series of 255 cases, with particular attention to the long-term outcome related to the disease process requiring LS. METHODS: From February 1993 to October 2003, LS was attempted in 255 patients (100 males and 155 females with a mean age of 45 +/- 19 years) and clinical information was recorded in a prospective database. Indications for splenectomy included idiopathic thrombocytopenic purpura (ITP) (n = 115), HIV-ITP (n = 9), Evans syndrome (n = 6), autoimmune hemolytic anemia (AIHA) (n = 13), hereditary spherocytosis (HS) (n = 19), hematologic malignancy (n = 66), thrombotic thrombocytopenic purpura (n = 1), and others (n = 26). Long-term postoperative follow-up evaluation was obtained through clinical notes, follow-up visits by the referring hematologist, and by phone interviews both with patients and with the referring hematologist. RESULTS: A total of 186 patients (73\%) were available for a mean follow-up of 35 months (range, 1-104). Of the ITP patients, 87 (76\%) were followed up, with a remission rate of 89\% (complete remission in 75\%). A similar remission rate was observed in ITP-HIV; in patients available for follow-up (78\%), complete remission was achieved in 83\%. In Evans, complete remission was achieved in all patients available for follow-up (67\%). Clinical response for hemolytic disease ranged between 70\% for AIHA and 100\% for HS. In the malignant group, the late mortality rate was 22\%. The mortality rate in the miscellaneous group was 5\%. No cases of splenectomy-related sepsis occurred during follow-up. CONCLUSIONS: LS offers advantages for all types of splenic diseases requiring surgery. It provides not only good clinical short-term outcome but also satisfactory long-term hematological results.
This article was published in Surg Endosc
and referenced in Surgery: Current Research