[Laparoscopic splenectomy, is it the gold standard?].
BACKGROUND
At the beginning of the last decade, different groups of workers developed almost simultaneously the laparoscopic splenectomy technique. From then on, and based on the accumulated experience done in the field, this technique has become the preferred approach.


OBJECTIVE
to analyze the results obtained with laparoscopic splenectomy on 29 patients with various pathologies.


METHODS
General Surgery Service Number 2, Prof. Pablo Mirizzi, Clinic National Hospital. General Surgery Service, Sucre Clinic, Córdoba.


METHODS
prospective study.


METHODS
Twenty-nine laparoscopic splenectomies were indicated in 22 cases of idiopatic thrombocytopenic purpura, 4 autoimmune hemolytic anemia, two spheroid and one segmental hypertension portal. A simultaneous prophylactic cholecistectomy was performed in cases of malign spheroid associated with cholelitiasis. Cases of incorrigible coagulopaty, ascitis and spleenomegaly, greater than 30 cm., were discarded. Antibiotic prophylaxis, bovine anti-pneumonic vaccine, drainage to the spleen cavity, precocious mobilization and liquid diet starting at 6 a.m. were systematically indicated.


RESULTS
there was no mortality and a patient with spleenomegaly of 28 cm. was converted (3.4%). The average surgical time was 90 minutes. In 4 cases (13.7%) of patients with ITP, accessory spleens were found. No patient was transfused when bleeding was less than approximiately 100cm. The main surgical difficulty was the spleen mobilization at the level of the pedicle in the big spleens and the hemorrhaging in small volumes during the dissection.


CONCLUSIONS
this technique offers a series of advantages that allow it to be considered as the new "gold standard" for splenectomy.
Gramática
Luis
L
Cátedra de Cirugia, Prof Dr Pablo L Mirizzi Hospital Nacional de Clinicas, Córdoba, Argentina.
Mercado Luna
Andrés
A
Brizuela
Adrián
A
Taborda
Bruno
B
Moreno
Walter
W
Verasay
Guillermo
G
D000293:Adolescent; D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000601:surgery; D001428:Bacterial Vaccines / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery; D013156:Splenectomy / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome
D001428:Bacterial Vaccines