Laparoscopic splenectomy for hereditary spherocytosis-preliminary report.
Splenectomy is considered standard surgical therapy in hereditary spherocytosis. The procedure is indicated in patients with severe anemia, recurrent hemolytic, and aplastic crises. The aim of the study was to assess treatment outcomes in patients with hereditary spherocytosis who underwent total or partial laparoscopic splenectomy. Fifteen patients aged 4-17 yr underwent laparoscopic splenectomy from 2009 to 2012. Partial and total splenectomies were performed (five and 10 children, respectively). Hematologic parameters, liver function tests, and splenic volume before and after the surgery were analyzed retrospectively. Total follow-up was 1-30 months. Hospitalization and operating time were similar in both groups. In partial splenectomy group, branches of splenic arteries gave better blood supply than short gastric vessels. In both groups, hematologic parameters were improved. Postoperative markedly elevated platelet count was maintained up to 6 months, and after that, platelet count gradually decreased to normal values. Bilirubin level was decreased in early postoperative period; however, it increased later to achieve levels lower than in preoperative period. No severe general infections were observed in both groups. Laboratory parameters (hemoglobin and bilirubin concentrations and RBC) after the surgery improved in all patients, and the effect was maintained during 12 months of follow-up. Platelet count increased significantly after the surgery and was maintained at high levels during the next 6 months. However, it returned to preoperative levels within a year after the surgery. Our study showed that partial splenectomy was not inferior to total splenectomy. However, full assessment requires longer follow-up and larger group of patients.
Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, Poland.
Robert
R
Rogulski
Department of Pediatric Haematology and Oncology, Medical University of Warsaw, Warsaw, Poland.
Anna
A
Adamowicz-Salach
Department of Pediatric Haematology and Oncology, Medical University of Warsaw, Warsaw, Poland.
Michał
M
Matysiak
Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, Poland.
Dariusz
D
Piotrowski
Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, Poland.
Michał
M
Gogolewski
Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, Poland.
Anna
A
Piotrowska
Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland.
Danuta
D
Roik
Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, Poland.
Andrzej
A
Kamiński
D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D010976:Platelet Count; D013103:Spherocytosis, Hereditary / Q000175:diagnosis / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D001663:Bilirubin
hereditary spherocytosis; laparoscopy; partial splenectomy; splenectomy