[Laparoscopic splenectomy for hematological diseases; results in 28 patients].
OBJECTIVE
To evaluate the first results of laparoscopic splenectomy for haematological diseases and the learning curve.


METHODS
Retrospective.


METHODS
Data of all patients who underwent a laparoscopic splenectomy in October 1994-July 1998 in the University Hospital Rotterdam, Department of surgery, the Netherlands, were collected from electronic databases. Data on postoperative complications were collected from medical records. Patients with splenomegaly (> 15 cm) were not eligible for the procedure.


RESULTS
28 patients were eligible for a laparoscopic splenectomy. The male:female ratio was 1:4. The mean age was 35 years. The indications for surgery were idiopathic thrombocytopenic purpura (ITP; n = 24), Gilbert syndrome (n = 1), spherocytosis (n = 1), thalassaemia (n = 1) and haemolytic anaemia with ITP (n = 1). Conversion to an open procedure was necessary in 5 of 28 laparoscopic splenectomies (18%). The median operating time was 172 minutes. Complications occurred in four patients: pneumonia (n = 2), bleeding (n = 1) and urosepsis (n = 1). The median hospital stay was 5 days (range: 1-18). The first 14 laparoscopic splenectomies differed from the following 14 by a higher conversion rate (p = 0.01), a longer operation time (p = 0.002) and a longer hospital stay (p = 0.004). In 23 out of 25 patients with ITP the thrombocyte count became normal.


CONCLUSIONS
Laparoscopic splenectomy is associated with a learning curve, with a high incidence of conversion in the early procedures. It appears to be a safe and effective operation.
den Hoed
P T
PT
Afd. Chirurgie, Academisch Ziekenhuis Rotterdam-Dijkzigt.
van Wessem
K J
KJ
Berends
F J
FJ
Kappers-Klunne
M C
MC
Kazemier
G
G
Bonjer
H J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods
Laparoscopische splenectomie voor hematologische aandoeningen; resultaten bij 28 patiënten.