[Splenectomy in autoimmune hematological diseases. Comparative study between laparoscopic and open technique].
BACKGROUND
We undertook this study to compare the outcome of laparoscopic and open splenectomy in the treatment of hematological diseases.


METHODS
This was a comparative study of two groups of patients. The study sample consisted of 37 patients divided into two groups: group I, open splenectomy (OS) and group II, laparoscopic splenectomy (LS). Twenty one consecutive patients with LS were compared to 16 randomized patients selected from clinical records of OS patients. General and specific variables were collected in Microsoft Access database and analyzed in SPSS for Windows statistical program. Statistical analysis was done.


RESULTS
Of 25 women and 12 men (37.2 +/- 16.9 years old), 6 had autoimmune hemolytic anemia, 29 idiopathic thrombocytopenic purpura (ITP), and two had Evans syndrome. Patients with ITP had preoperative platelet count of 74.6 +/- 64.1/mm(3) and patients with autoimmune hemolytic anemia had a preoperative hemoglobin of 10.6 +/- 2.9 g/dl. Ten patients had co-morbidity. There were 16 OS and 21 LS. Size of spleen was 13.1 +/- 3.7 cm and weight was 178 +/- 115 g. Surgical time for OS was 69.3 +/- 21.7 min and for LS was 152.8 +/- 61.1 min (p <0.05). Operative bleeding for OS was 300 +/- 265 ml and for LS it was 265 +/- 198 ml (p >0.05). One patient in LS group had red cell transfusion and two in the same group had to be converted to OS to reassure hemostasis. Reoperations had to be done in the OS group, two to control bleeding and one with a left lobe hepatic hematoma. There was no mortality. Postoperative platelet count in patients with ITP increased to 246 +/- 159 and hemoglobin in patients with hemolytic anemia increased to 12.1 +/- 3.6 g (p <0.05). Hospital stay in OS was 5.06 +/- 3.6 days vs. 2.06 +/- 0.26 in LS (p <0.05). Patients in OS had 30.6 +/- 10.5 lost work days vs. 15.5 +/- 4.6 in LS group (p <0.05).


CONCLUSIONS
It is possible to treat patients with hematological diseases with LS. LS is time-consuming compared to OS. Morbidity in LS may be less than in OS. Mortality may be zero. Hospital stay and postoperative lost work days are less in LS than with OS. LS may be the gold standard in treatment of patients with hematological diseases.
Campos-Campos
Salvador Francisco
SF
Hospital de Especialidades Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social. drfcampos@prodigy.net.mx
Lara-Olmedo
José Luis
JL
Cervantes-Cruz
Jorge
J
Licona-Hernández
Juan Carlos
JC
Delgadillo-Teyer
Germán
G
Garcés-Monterrubio
Manuel Gonzalo
MG
D000293:Adolescent; D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000601:surgery*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012086:Reoperation; D013156:Splenectomy / Q000379:methods*