title: Residual splenic function after laparoscopic splenectomy: a clinical concern.
abstract: OBJECTIVE
  To document the existence of residual splenic function after laparoscopic splenectomy in a series of 48 patients.
  
  
  METHODS
  A noncomparative descriptive case series.
  
  
  METHODS
  A tertiary care center.
  
  
  METHODS
  A series of 9 patients without clinical improvement after laparoscopic splenectomy of 48 consecutive patients undergoing laparoscopic splenectomy for several hematologic disorders after a mean follow-up of 16 months (range, 1-40 months).
  
  
  METHODS
  A computed tomographic scan and technetium Tc 99m sodium pertechnetate heat-damaged red blood cell scintigraphy were performed for patients with partial (platelet count <100x10(9)/L) or total (platelet count <50x10(9)/L) failure of improvement.
  
  
  METHODS
  Evidence of residual splenic tissue by image diagnosis.
  
  
  RESULTS
  The condition of 9 of the 48 patients failed to improve after laparoscopic splenectomy. Six patients experienced a total failure of improvement and 3 experienced a partial failure of improvement (1 patient had human immunodeficiency virus-related thrombocytopenia and 8 had idiopathic thrombocytopenic purpura). Three patients had residual splenic function, which was revealed by scintigraphy. The results of a computed tomographic scan showed an accessory spleen in one patient and splenic implants in splenic fossa in another patient.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy has a promising role in the management of hematologic diseases requiring splenectomy, but it requires exquisite care to avoid parenchymal rupture and cell spillage and to avoid leaving accessory spleens, which can lead to the failure of surgical treatment.
authors.affiliation: Service of General and Digestive Surgery, Hospital Clinic, University of Barcelona, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: Targarona
authors.forename: J J
authors.initials: JJ
authors.lastname: Espert
authors.forename: C
authors.initials: C
authors.lastname: Balagué
authors.forename: G
authors.initials: G
authors.lastname: Sugrañes
authors.forename: C
authors.initials: C
authors.lastname: Ayuso
authors.forename: F
authors.initials: F
authors.lastname: Lomeña
authors.forename: F
authors.initials: F
authors.lastname: Bosch
authors.forename: M
authors.initials: M
authors.lastname: Trias
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011184:Postoperative Period; D013154:Spleen / Q000002:abnormalities* / Q000502:physiology*; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome