Impact of hematological diagnosis on early and late outcome after laparoscopic splenectomy: an analysis of 111 cases.
BACKGROUND
Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS patients.


METHODS
We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided into group 1A, idiopathic thrombocytopenic purpura (ITP) (n = 48) and group 1B, HIV-related ITP (n = 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n = 8), and group 2B, spherocytosis (n = 11); (c) group 3, malignancy (n = 28); and (d) group 4, others (n = 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean follow-up of 24 +/- 18 months.


RESULTS
There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity, although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups 3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in >/=75% of patients (group 1A, 82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality was 6.2%, mainly due to deaths in group 4 (six of 22 patients).


CONCLUSIONS
LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a long-term hematological response comparable to the standard results that have been observed in open series.
Trias
M
M
Service of General and Digestive Surgery, Hospital de S. Pau, Autonomous University of Barcelona, C/P Claret 167, 08025 Barcelona, Spain.
Targarona
E M
EM
Espert
J J
JJ
Cerdan
G
G
Bombuy
E
E
Vidal
O
O
Artigas
V
V
D016009:Chi-Square Distribution; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome