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Feasibility and safety of emergency laparoscopic partial splenectomy: A retrospective analysis.

Abstract The increased awareness of asplenia-related life-threatening complications has led to the development of parenchyma sparing splenic resections in past few years. The aim of this study is to retrospectively analyze the feasibility and safety of laparoscopic partial splenectomy (LPS) in selected emergency patients.From January 2013 to December 2015, there were 46 emergency patients, diagnosed with splenic rupture, admitted in our department. Selection criteria for LPS: (1) Preoperative CT scan revealed single pole rupture without spleen pedicle injury; (2) BP>90/60 mm Hg and heart rates <120 bpm; (3) No sigh of multiple organ injury. Eventually, LPS was performed in 21 patients (Group LPS), while laparoscopic splenectomy (LS) was performed in 20 patients (Group LS).The main cause of splenic rupture was traffic accident, followed by blunt injury and high falling injury. Abdominal CT scan showed the mean longitudinal diameter of spleen of group LPS was 14.2 ± 1.8 cm (range 12-17 cm), while the size of remnant spleen was 5.5 ± 1.2 cm. Between 2 groups, operation time (LPS: 122.6 ± 17.2 min vs LS: 110.5 ± 18.7 minutes, P = .117), and intraoperative blood loss (LPS: 174 ± 22 mL vs LS: 169 ± 29 mL, P = .331) were similar. There were 2 patients suffered subsequent unstable vital sign altering during mobilization when performing LPS. Conversion to LS (2/21, 9.52%) was decided and successfully completed. Although there was no patient suffered postoperative OPSI or thrombocytosis events in both groups after 6-month follow-up, the mean platelets and leukocyte count were significantly lower in group LPS. Splenic regrowth was evaluated in 20 patients of group LPS. And the mean regrowth of splenic volume reached 19% (10%-26%).Due to its minimal invasive effect and functional splenic tissue preservation, LPS may be a safe and feasible approach for emergency patients. And prospective trials with clear inclusion criteria are needed to proof the benefit of LPS.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422834
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Feasibility and safety of emergency laparoscopic partial splenectomy: A
      retrospective analysis.
PG  - e6450
LID - 10.1097/MD.0000000000006450 [doi]
AB  - The increased awareness of asplenia-related life-threatening complications has
      led to the development of parenchyma sparing splenic resections in past few
      years. The aim of this study is to retrospectively analyze the feasibility and
      safety of laparoscopic partial splenectomy (LPS) in selected emergency
      patients.From January 2013 to December 2015, there were 46 emergency patients,
      diagnosed with splenic rupture, admitted in our department. Selection criteria
      for LPS: (1) Preoperative CT scan revealed single pole rupture without spleen
      pedicle injury; (2) BP&gt;90/60 mm Hg and heart rates &lt;120 bpm; (3) No sigh of
      multiple organ injury. Eventually, LPS was performed in 21 patients (Group LPS), 
      while laparoscopic splenectomy (LS) was performed in 20 patients (Group LS).The
      main cause of splenic rupture was traffic accident, followed by blunt injury and 
      high falling injury. Abdominal CT scan showed the mean longitudinal diameter of
      spleen of group LPS was 14.2 +/- 1.8 cm (range 12-17 cm), while the size of
      remnant spleen was 5.5 +/- 1.2 cm. Between 2 groups, operation time (LPS: 122.6
      +/- 17.2 min vs LS: 110.5 +/- 18.7 minutes, P = .117), and intraoperative blood
      loss (LPS: 174 +/- 22 mL vs LS: 169 +/- 29 mL, P = .331) were similar. There were
      2 patients suffered subsequent unstable vital sign altering during mobilization
      when performing LPS. Conversion to LS (2/21, 9.52%) was decided and successfully 
      completed. Although there was no patient suffered postoperative OPSI or
      thrombocytosis events in both groups after 6-month follow-up, the mean platelets 
      and leukocyte count were significantly lower in group LPS. Splenic regrowth was
      evaluated in 20 patients of group LPS. And the mean regrowth of splenic volume
      reached 19% (10%-26%).Due to its minimal invasive effect and functional splenic
      tissue preservation, LPS may be a safe and feasible approach for emergency
      patients. And prospective trials with clear inclusion criteria are needed to
      proof the benefit of LPS.
FAU - Li, Hongyu
AU  - Li H
AD  - aDepartment of Pancreatic Surgery, West China Hospital, Sichuan University,
      Chengdu, Sichuan Province bDepartment of Liver Surgery, West China Hospital,
      Sichuan University, Chengdu, Sichuan Province, China.
FAU - Wei, Yonggang
AU  - Wei Y
FAU - Peng, Bing
AU  - Peng B
FAU - Li, Bo
AU  - Li B
FAU - Liu, Fei
AU  - Liu F
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006450 [doi]
AID - 00005792-201704210-00015 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6450. doi: 10.1097/MD.0000000000006450.

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