ABSTRACT
BACKGROUND: Multiple techniques for splenectomy are now employed and include open, laparoscopic and hand-assisted laparoscopic splenectomy (HALS). Concerns regarding a purely laparoscopic splenectomy for massive splenomegaly (> 20 cm) arise from potentially longer operative times, higher conversion rates and increased blood loss. The HALS technique offers the potential advantages of laparoscopy, with the added safety of having the surgeon's hand in the abdomen during the operation. In this study, we compared the HALS technique to standard open splenectomy for the management of massive splenomegaly. METHODS: We reviewed all splenectomies performed at 5 hospitals in the greater Vancouver area between 1988 and 2007 for multiple demographic and outcome measures. Open splenectomies were compared with HALS procedures for spleens larger than 20 cm. Splenectomy reports without data on spleen size were excluded from the analysis. We performed Student t tests and Pearson χ(2) statistical analyses. RESULTS: A total of 217 splenectomies were analyzed. Of these, 39 splenectomies were performed for spleens larger than 20 cm. We compared the open splenectomy group (19 patients) with the HALS group (20 patients). There was a 5% conversion rate in the HALS group. Estimated blood loss (375 mL v. 935 mL, p = 0.08) and the mean (and standard deviation [SD]) transfusion rates (0.0 [SD 0.0] units v. 0.8 [SD 1.7] units, p = 0.06) were lower in the HALS group. Length of stay in hospital was significantly shorter in the HALS group (4.2 v. 8.9 d, p = 0.001). Complication rates were similar in both groups. CONCLUSION: Hand-assisted laparoscopic splenectomy is a safe and effective technique for the management of spleens larger than 20 cm. The technique results in shorter hospital stays, and it is a good alternative to open splenectomy when treating patients with massive splenomegaly.
Subject(s)
Blood Loss, Surgical , Laparoscopy/methods , Splenectomy/methods , Splenomegaly/surgery , Adult , Aged , British Columbia , Female , Hand , Humans , Laparoscopy/adverse effects , Laparoscopy/statistics & numerical data , Male , Middle Aged , Splenectomy/adverse effects , Splenectomy/statistics & numerical data , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The aim of this study was to evaluate the influence of patient and adenoma characteristics on (99m)Tc-methoxy isobutyl isonitrile (MIBI) scan performance in individuals diagnosed with primary hyperparathyroidism (PHP). METHODS: Records of patients undergoing parathyroidectomy for PHP over 6 years at a single center were reviewed. RESULTS: The overall true-positive (TP) rate for (99m)Tc-MIBI scans was 56%. Adenomas sized 1.9 to 3.5 cm were more likely to have TP scans than 0.3-cm to 1.8-cm adenomas (74% vs 40%, P < .001). Preoperative ionized calcium levels between 1.49 and 1.72 mmol/L were more likely to have TPs than levels between 1.27 and 1.48 mmol/L (65% vs 47%, P < .05). No single class of medication was shown to significantly effect TP rates. A decrease in TP rate was observed for larger adenomas in patients on >or=1 medication (74% vs 65%, P = .05). CONCLUSIONS: In PHP, (99m)Tc-MIBI scan positivity is most related to adenoma size and preoperative ionized calcium level.
Subject(s)
Adenoma/diagnostic imaging , Hyperparathyroidism, Primary/diagnostic imaging , Parathyroid Neoplasms/diagnostic imaging , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon/methods , Adenoma/pathology , Adenoma/surgery , Aged , Cohort Studies , False Positive Reactions , Female , Humans , Hyperparathyroidism, Primary/pathology , Hyperparathyroidism, Primary/surgery , Male , Middle Aged , Parathyroid Neoplasms/pathology , Parathyroid Neoplasms/surgery , Parathyroidectomy/methods , Preoperative Care/methods , Probability , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Treatment OutcomeABSTRACT
BACKGROUND: The aim of this study was to review 5 years of laparoscopic adjustable gastric band (LAGB) procedures in which low-pressure bands were used. METHODS: All LAGB cases at the authors' center were retrospectively analyzed. A survey of these patients was conducted in 2008 and 2009. RESULTS: Of 90 LAGB patients, 86 were surveyed. Follow-up averaged 17.5 months. Weight loss averaged 24.8 +/- 19.4 kg. Weight loss averaged 2.7 kg/mo and did not significantly drop over the last 10.7 months (2.7 vs 1.5 kg/mo, P = .16). Excess body weight loss was 27.5%, 39.1%, and 67.2% in the first, second, and following years, respectively. Patients averaged 4.14 adjustments of their bands and vomited 2.13 times per week. The mortality rate was 0%. No band slippages or band erosion occurred. Resolution or improvement occurred in most obesity-related illness. Gastroesophageal reflux disease symptoms worsened in 25% of patients. CONCLUSIONS: These results replicate world LAGB literature. Low complication rates result either from the authors' band or their techniques.
