title: [Comparison of laparoscopic splenectomy in supine position with hanging-spleen technique in idiopathic thrombocytopenic purpura].
abstract: BACKGROUND
  Laparoscopic splenectomy has become the gold standard intervention for elective splenectomy. Several techniques have been described, which differ in trocar localisations and patient positions. The hanging-spleen technique was examined in comparison to the conventional laparoscopic splenectomy in the supine position among the patient population in our institution over a period of 8 years.
  
  
  METHODS
  On the basis of a retrospective analysis, data were collected on all patients who underwent elective laparoscopic splenectomy for idiopathic thrombocytopenic purpura between May 1994 and April 2002 and were examined for operation time, blood loss and peri-operative complications. Two types of operation were compared, the conventional laparoscopic splenectomy in the supine position (group A) and the hanging-spleen technique (group B). Finally, the costs of materials of the two operation techniques were compared.
  
  
  RESULTS
  For 51 patients (43.1 % men, 56.9 % women) (mean age: 45.5 ± 17.5 years) the mean operation times were 134.2 ± 47.3 min (group A) and 9.8 ± 39.9 min (group B). The mean blood losses were 691.3 ± 544.4 mL in group A and 638.3 ± 1050.6 mL in group B. The perioperative complications were 38.8 % in group A and 21.2 % in group B. There was no significant difference found for operation time, blood loss and perioperative complications in a multivariate analysis. The cost of materials was reduced in group B (use of Endo-GIA 42.4 % in group B, 100 % in group A). In group A 4 incisions, in group B 3 incisions were necessary.
  
  
  CONCLUSIONS
  Regarding operation time, blood loss and perioperative complications the 2 laparoscopic techniques for splenectomy do not differ significantly. Merely reduced material costs and a reduction of incisions were found in patients -operated with the hanging-spleen technique. Whether the hanging-spleen technique is the method of choice will have to be shown by further prospective studies.
authors.affiliation: Klinikum der Universität München, Chirurgische Klinik und Poliklinik Innenstadt, München, Deutschland. patrick.delhey@med.uni-muenchen.de
authors.forename: P R
authors.initials: PR
authors.lastname: Delhey
authors.forename: S
authors.initials: S
authors.lastname: Mayer
authors.forename: D
authors.initials: D
authors.lastname: Buerklein
authors.forename: T P
authors.initials: TP
authors.lastname: Hüttl
authors.forename: K-W
authors.initials: KW
authors.lastname: Jauch
authors.forename: M W
authors.initials: MW
authors.lastname: Wichmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D017046:Cost Savings; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011697:Purpura, Thrombotic Thrombocytopenic / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000191:economics / Q000379:methods*; D016683:Supine Position; D055815:Young Adult