Laparoscopic splenectomy at Middlemore Hospital, New Zealand: a safe procedure with heterogeneous indications.
OBJECTIVE
To perform an audit on a decade of laparoscopic splenectomy (LS) at Middlemore Hospital.


METHODS
Electronic case records of patients who had undergone LS from 1996 to 2005 were reviewed. Data were collected on demographics, operative time, hospital stay, complication rates, conversion rates, and haematological response rates.


RESULTS
Forty-two patients (14 male, 28 female) were analysed. Mean age was 53 years (16-91 years), and the mean follow-up was 22 months. The indication for surgery was idiopathic thrombocytopaenic purpura [ITP] (47.6%), haematological malignancy [HM] (40.5%), haemolytic anaemia [HA] (9.5%), and Evan's syndrome (2.4%). Median operating time was 112.0 (60-188) minutes, and median hospital stay was 5 (3-11) days, with a significant increase in the length of hospital stay for those converted. Four operations (9.5%) were converted to open surgery and there was a 26.2% morbidity rate and 0% mortality rate. Haematological response rates were as follows: ITP-complete in 70.0%, partial in 25.0% and none in 5.0%; HA-complete in 75.0%, none in 25%; and HM-desirable response in 88.2%.


CONCLUSIONS
In Middlemore Hospital, LS can be performed safely. The haematological responses to surgery compare favourably with meta-analyses of LS, as well as with responses seen in open surgery.
Department of Surgery, Middlemore Hospital, Otahuhu, Auckland, New Zealand. gpoole@middlemore.co.nz
Tarik
T
Sammour
Garth
G
Poole
Adam
A
Bartlett
Hilary
H
Blacklock
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006801:Humans; D045823:Ileus / Q000209:etiology; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D013156:Splenectomy / Q000009:adverse effects / Q000534:rehabilitation / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome