safer splenectomy with critical thrombocytopenia: preoperative splenic artery embolization

Portal hypertension is sometimes associated with hypersplenism and pancytopenia. Splenectomy cures the hypersplenism in these circumstances. The presence of critical thrombocytopenia is usually associated with high morbidity and mortality of the splenectomy procedure. To evaluate the effect of preoperative splenic artery embolization on the outcome of splenectomy in these circumstances. From April 2000 to June 2002, 23 patients with pancytopenia associating portal hypertension were selected to be enrolled in the study. All patients had splenic artery embolization as a preoperative measure to improve their thrombocytopenic state. This was followed by a surgical splenectomy after reaching a platelet count above 100,000 /cm3. Post embolization all patients showed a progressive increase in platelet count from a mean of 51000/ cm3 to a mean of 122000/cm3 on day 6. Complications of the embolization procedure were bleeding at the puncture site, portal vein thrombosis, splenic abscess, and systemic sepsis. Complications of the splenectomy procedure were one mortality, post operative Heeding in one case, chest infection in one case and wound infection in 2 cases. Preoperative splenic artery embolization can be used to improve the outcome of splenectomy in the presence of thrombo-cytopenia. The technique should be used selectively and only when platelet counts drop below 50000/cm3 [critical thrombocytopenia]. Splenectomy timing at day 6 post embolization is safe as thrombocytopenia was corrected at that time in all patients

Mini laparotomy a valid cost effective option for cholecystectomy

Laparoscopic cholecystectomy is replacing the use of conventional open cholecystectomy and minilaparotomy cholecystectomy for removal of the gall bladder. The authors have studied the indications, technique, postoperative course and complications of minilaparotomy cholecystectomy on 154 patients with the aid of custom made retractors. The authors conclude that minilaparotomy cholecystectomy is a valid cost effective option for removal of the gall bladder in selected cases. Experience with the procedure is neccessary and it can be an excellent alternative to either laparoscopic cholecystectomy or conventional open cholecystectomy giving patients a short hospital stay and early recovery with a low complication rate together with a reduced cost omitting the need for sophisticated equipment

Esophagectomy by inversion stripping and stapled esophago-gastroanastomosis: a cadaveric and animal study

Numerous esophagectomy techniques are available, of them transhiatal esophagectomy gives lower morbidity and mortality than esophagectomy involving a thoracotomy. The new technique of esophageal stripping with stapled esophagogastric anastomosis was peirformed on 8 human cadavers and on 9 live dogs. Stripping in a neck to abdomen direction was easy, quick and safe. Modifying the stripper head to accept the two wire ends made pulling up the stomach to the neck easy and safe. Using staplers to perform the procedure decreased the operative time. The authors think that this new technique is suitable for esophagectomy for upper 1/3 and lower 1/3 esophageal tumours as well as for esophagectomy for all benign conditions requiring removal of the esophagus