title: Value and risk of laparoscopic surgery in hemophiliacs-experiences from a tertiary referral center for hemorrhagic diatheses.
abstract: OBJECTIVE
  Laparoscopic surgery (LS) is gaining popularity worldwide because of benefits like faster recovery, earlier hospital discharge, and better cosmetic results. In hemophiliacs, surgery in general harbors an increased risk for severe complications. Whether LS or conventional surgery (CS) should be recommended in these patients is controversial and therefore the issue of our present study.
  
  
  METHODS
  We performed a retrospective matched-pair analysis including laparoscopically operated non-hemophiliacs (LONH), laparoscopically operated hemophiliacs (LOH), and conventionally operated hemophiliacs (COH) concerning duration of surgery, drainages, hospital stay, complications, factor use (VIII, IX, and X), and blood values. Mann-Whitney U test was used (significance level P = 0.05).
  
  
  RESULTS
  No significant differences were found in duration of surgery and drains in laparoscopically or conventionally operated hemophiliacs versus matched pairs. Complication rate did not differ among the different groups. Concerning the total duration of hospital stay (t-DHOS) and the postoperative duration of hospital stay (p-DHOS), there was no statistical difference between LOH versus matched LONH. However, in COH versus matched LOH, a longer time was required for preparation and recovery (t-DHOS, P = 0.04; p-DHOS, P < 0.001). Also, the median factor supply perioperatively including the day of surgery did not differ between laparoscopically versus conventionally operated hemophiliacs.
  
  
  CONCLUSIONS
  Our study underscores the safety and benefits of laparoscopic procedures in hemophiliacs by showing a significantly shorter hospital stay for these patients resulting in reduced therapeutic costs and a faster mobilization. Still, the surgical and perioperative management of hemophiliacs continues to be a challenge requiring an experienced interdisciplinary team.
authors.affiliation: Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lingohr
authors.forename: Safia
authors.initials: S
authors.lastname: Bensoukehal
authors.forename: Hanno
authors.initials: H
authors.lastname: Matthaei
authors.forename: Jonas
authors.initials: J
authors.lastname: Dohmen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nadal
authors.forename: Tim Oliver
authors.initials: TO
authors.lastname: Vilz
authors.forename: Arne
authors.initials: A
authors.lastname: Koscielny
authors.forename: Johannes
authors.initials: J
authors.lastname: Oldenburg
authors.forename: Jörg Christoph
authors.initials: JC
authors.lastname: Kalff
authors.forename: Georg
authors.initials: G
authors.lastname: Goldmann
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data; D016022:Case-Control Studies; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006467:Hemophilia A / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006474:Hemorrhagic Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D012016:Reference Values; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome