A ten-year, single institution experience with laparoscopic splenectomy.

BACKGROUND AND OBJECTIVES: Laparoscopic splenectomy (LS) is now widely performed and is considered the standard of care for the treatment of certain diseases of the spleen. Although multiple studies have documented the safety and feasibility of laparoscopic splenectomy, little long-term data are available. We present a 10-year, single institution experience with laparoscopic splenectomy to determine trends in procedural outcome data. METHODS: Laparoscopic splenectomy was performed in 109 consecutive, unselected patients with benign or malignant hematological diseases from March 1992 to November 2001. A prospective, longitudinal database, medical record review, and patient interviews were used for data acquisition. During the last 10-years, the annual number of laparoscopic splenectomy was relatively constant. Therefore, patients were divided into 2 cohorts, comparing the first 55 consecutive patients (Group I) with the subsequent 54 patients (Group II) who underwent LS. Data were analyzed using the unpaired Student t test, with values of P < 0.05 considered significant. RESULTS: Mean patient age was 39 years (range, 6 to 79) in Group I and 45 years (range, 13 to 77) in Group II. Total operative time was 151 minutes in Group I and 159 minutes in Group II (NS), estimated blood loss averaged 544 mm in Group I and 308mm in Group II (P = 0.015). The mean specimen weight of the spleen was 288 g in Group I and 512 g in Group II (P = 0.03). Morbidity occurred in 7 of the first 55 patients (13%) and 5 of the next 54 patients (9%). Additionally, 7 conversions to an open operation were necessary in Group I (13%) versus only 1 conversion in Group II (2%). CONCLUSION: A decade of experience with LS shows that it can be performed safely for a wide variety of indications. Over the last 10 years, the average spleen size has increased, yet a significant reduction in blood loss and conversion rate has been achieved.

Surgeon-performed endoscopic dilatation of symptomatic gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: With increasing performance of Roux-en-Y gastric bypass (RYGBP), the postoperative complications are becoming more apparent. Gastrojejunal anastomotic strictures develop in 4.7 to 27% of patients undergoing laparoscopic RYGBP. This paper details two endoscopic techniques for dilating gastrojejunal anastomotic strictures. METHODS: 3 patients developed gastrojejunal anastomotic strictures. In each patient, the operating surgeon performed a diagnostic upper endoscopy, followed by stricture dilatation using either Savary or balloon method. RESULTS: Patients lost a mean weight of 42 kg (range 33-50 kg) before definitive stricture treatment. Once adequately dilated, all patients received an excellent symptomatic result. CONCLUSIONS: For the treatment of gastrojejunal anastomotic strictures, both Savary and balloon dilatation have been efficacious and easy to perform. The endpoint for stricture dilatation is 12 mm or slightly larger. The operating surgeon should acquire a working knowledge of these techniques.