[Laparoscopic splenectomy: indications, techniques, outcomes].
Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include a preoperative radiologic assessment to measure splenic volume and to detect the presence of accessory splenic tissue; the patient should undergo preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections. Prophylactic antibiotics are used in the perioperative period as well as prophylactic anticoagulation therapy which may be continued long-term in high-risk patients. LS is associated with a low morbidity and mortality; when compared to laparotomy, it reduces the length of hospital stay and improves the quality of life by decreasing postoperative ileus and pain. There are a variety of laparoscopic approaches; the hand-assisted technique and newer coagulating devices have facilitated the operative technique leading to increasing acceptance of laparoscopy as the preferred approach - even in patients with malignant hematologic disease and/or massive splenomegaly.
Borie
F
F
Service de chirurgie digestive B, CHU Carémeau, place de Pr-Debré, 30029 Nimes, France. frederic.borie@chu-mines.fr
Philippe
C
C
D019072:Antibiotic Prophylaxis; D002986:Clinical Trials as Topic; D000075202:Contraindications; D003560:Cysts / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D011183:Postoperative Complications; D011860:Radiography, Abdominal; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013160:Splenic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D013163:Splenomegaly / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome