RESUMO
PURPOSE: Concerns about patients experiencing overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures, and the advanced understanding of splenic vascular anatomy has permitted splenic preserving operations and conservative medical management. These are now accepted alternative procedure when dealing with pathologically benign splenic conditions and traumatic splenic injuries. The aim of the present paper was to evaluate the effectiveness and safety to this new spleen conserving procedure compare to open splenectomy. METHODS: From December 1999 through April 2004, five patients with splenic cysts who were treated by splenectomy and laparoscopic function preserving surgery (LFPS) were enrolled in this study. We analyzed the operation time, the amount of blood loss, the time to restart a regular diet, the hospital stay and the postoperative CT to retrospectively confirm the results of the operations. RESULTS: In four cases, the pathologic findings were splenic pseudocysts, and the other case was a cystic lymphangioma. The operative times were 138 minutes (range: 120~156 minutes) for LFPS and 130 minutes (range: 100~170 minutes) for total splenectomy. The amounts of blood loss were 20~30 cc for LFPS, and 20~800 cc for open splenectomy. For LFPS, the patients started their diet at postoperative day 1st and they were discharged at 4th (range: 3~5) day without complication. But for total splenectomy, normal diet was started at the 3rd day (range: 2~4) and they were discharged at the 11th day (range: 3~22) and one patient had complications. For LFPS, on the CT that was done 3 month after operation, we confirmed the complete excision of cysts without any operation related complication, there was no evidence of recurrence and the splenic parenchyme was preserved in a normal fashion in all cases. CONCLUSION: The success and relative ease of performing this laparoscopic function preserving procedure will pave the way for its future use in other selective cases involving splenic pathology.