title: The feasibility and effectiveness of a hand-assisted laparoscopic splenectomy for hypersplenism in patients after living-donor liver transplantation.
abstract: BACKGROUND
  A laparoscopic splenectomy in patients who previously underwent living-donor liver transplantation (LDLT) is thought to be technically difficult because of the presence of severe adhesions and splenomegaly. This report documents the efficacy and safety of a hand-assisted laparoscopic splenectomy (HALS) for hypersplenism in patients after LDLT.
  
  
  METHODS
  Five patients underwent HALS for hypersplenism after LDLT between 1999 and 2007. The medical records of those patients were retrospectively evaluated.
  
  
  RESULTS
  The mean operative time was 237+/-12 minutes. The mean blood loss was 229+/-100 mL and the mean weight of excised spleen was 461+/-46 g. There was no conversion to open surgery. The number of platelets and leukocytes were significantly increased after surgery. No major complications were observed except for a patient who suffered paralytic ileus postoperatively. The mean hospital stay after the operation was 16.7+/-2.5 days.
  
  
  CONCLUSIONS
  HALS for patients after LDLT is a feasible and safe procedure. This technique can thus become a standard procedure after LDLT.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Uehara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Nao
authors.initials: N
authors.lastname: Kinjo
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery*; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D013158:Splenic Diseases / Q000601:surgery; D013997:Time Factors; D000267:Tissue Adhesions / Q000601:surgery