Laparoscopic versus open splenectomy in the management of hematologic diseases

Splenectomy is the best available treatment for severe forms of hereditary spherocytosis, idiopathic thrombocytopenic purpura, and other hematologic conditions when these prove refractory to conservative management. It has been employed for many decades with low mortality and favorable remission rates. The use of laparoscopic splenectomy in recent years has been rapidly and even enthusiastically adopted in this field. However, the exact role of laparoscopic versus open surgery for hematologic diseases is still debated. In this study of 58 adult patients, laparoscopic procedures were compared with conventional splenectomies for similar indications. METHODS: All patients were operated on within an 8-year period. Subjects underwent similar procedures under the supervision of the same surgical school and were compared regarding age, gender, body mass index, and diagnosis. Laparoscopically managed cases (Group I, n = 30) were prospectively followed according to a written protocol, whereas the same investigation was retrospectively done with regard to traditional laparotomy (Group II, n = 28). Methods included general and demographic findings, duration and technical steps of operation, blood loss, weight of spleen, need for conversion (in minimally invasive subjects), intraoperative and postoperative complications, time until realimentation, postoperative hospitalization, mortality, and late follow-up including recurrence rate. RESULTS: Idiopathic thrombocytopenic purpura was the surgical indication in over 50 percent of the patients in both groups, but familial spherocytosis, thalassemia, myelodysplasia, and lymphomas were also represented in this series. Laparoscopic procedures took more time to perform (P = 0.004), and postoperative hospitalization was 2 days shorter, but this difference was not statistically significant. Postoperative hematocrit and volume of blood transfusions was equivalent, although the laparoscopic cases had a somewhat lower preoperative hematocrit (NS) and displayed better recovery for this measurement (P = 0.03). More patients in Group I were able to accept oral food on the first day than subjects undergoing conventional operations (P < 0.05). Relatively few conversions were necessary during the minimally invasive surgeries (13.3 percent), and postoperative early and late complications as well as recurrences occurred in similar proportions. Also, the mean weight of the spleen was not statistically different between the groups,...

O metodo laparoscopico na avaliacao pre-operatoria de pacientes com neoplasia maligna do estomago / Laparoscopic method in preoperative evaluation of the patients with malignant stomach neoplasms

A eficiencia do metodo laparoscopico para diagnostico de disseminacao tumoral intra-abdominal foi avaliada em 190 pacientes com neoplasia maligna do estomago. Ao exame laparoscopico avaliou-se invasao tumoral da serosa gastrica, dos epiplons, do peritonio e do figado. O tratamento cirurgico foi contra-indicado em 34 pacientes, sendo que em 70,6 por cento pela contribuicao oferecida pelo exame laparoscopico que comprovou metastases hepaticas e/ou peritoniais nao detectadas pelo exame clinico e/ou procedimentos propedeuticos empregados como metodos de estadiamento. No restante dos casos (29,4 por cento) nao foi possivel a terapeutica cirurgica devido a desnutricao, insuficiencia cardiaca ou respiratoria e outras causas clinicas. Os achados laparoscopicos e cirurgicos foram comparados em 156 pacientes levando a concluir que: a sensibilidade para detectar disseminacao tumoral foi de 61,4 por cento para metastases na serosa gastrica, 21,4 por cento no epiplon, 27 por cento no peritonio parietal e 33,3 por cento no figado. Os achados laparoscopicos positivos sao confiaveis, uma vez que os falso-positivos sao frequentes (5 por cento). Os resultados mostram elevada especificidade do procedimento (97,9 por cento).