Zübeyir BOZDAĞ, Ahmet TÜRKOĞLU, BEKİR TAŞDEMİR, Abdullah OĞUZ, Sinan DAL, Abdullah KARAKUŞ, Hıdır BUDAK, Metehan GÜMÜŞ

Laparoskopik splenektomi klinik deneyimimiz: 38 hastanın sonuçları

Amaç: Laparoskopik splenektomi hematolojik hastalıkların tedavisinde son dönemlerde yaygın olarak kabul görmeye başlamıştır. Bu çalışmada laparoskopik splenektomi uyguladığımız hastalarımızın sonuçlarını sunmayı amaçladık. Yöntemler: Kliniğimizde 2012 2015 yılları arasında hematolojik hastalıklar nedeniyle laparoskopik splenektomi yapılan 38 hastanın kayıtları retrospektif olarak incelendi. Bulgular: Laparoskopik splenektomi uygulanan hastaların 15i erkek, 23ü kadın olup, ortalama yaş 33,9 ± 12,9 idi. Splenektomi endikasyonları; 34 hasta idiyopatik trombositopenik purpura (ITP), 4 hasta herediter sferositoz (HS) idi. Cerrahi eksplorasyonda 7 hastada aksesuar dalak tespit edilerek çıkarıldı. Safra kesesinde taş olan 2 HSli hastaya aynı seansta laparoskopik kolesistektomi uygulandı. Bir hastada diseksiyon esnasında görüşü engelleyen hemoraji nedeniyle açığa geçildi. Postoperatif dönemde bir hastada atelektazi ve bir hastada yara yerinde yağ nekrozu gelişti. Ayrıca bir hastada trombositoz gözlendi. ITPli 4 hastada geçici, iki hastada kalıcı refrakter trombositopeni nedeniyle hematolojik tedaviye devam edildi. Bu hastalara operasyon sonrası yapılan dalak sintigrafisinde bir hastada aksesuar dalak tespit edildi. Ortalama hastanede yatış süresi 2,6 ± 0,7 gün olarak bulundu. Sonuç: Hematolojik hastalık nedeniyle uygulanacak splenektomilerde laparoskopik splenektomi; daha az hastanede kalış süresi ve morbidite ile ilk seçenek tedavi modalitesi olarak düşünülebilir.

Our clinical experience on laparoscopic splenectomy: Outcomes of 38 patients

Objective: Laparoscopic splenectomy has gained widespread acceptance in the treatment of hematological diseases in recent years. In this study, we aimed to present the outcomes of the patients who underwent laparoscopic splenectomy. Methods: Between 2012 and 2015, the data of 38 patients, who underwent laparoscopic splenectomy for hematological diseases at our clinic, were evaluated retrospectively. Results: 15 males and 23 females patients were underwent laparoscopic splenectomy, and the average age was 33.9 ± 12.9 years. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP) in 34 patients, and hereditary spherocytosis in 4 patients. During the surgical exploration, accessory spleen was detected in 7 patients, and removed. Laparoscopic cholecystectomy was performed at the same session in 2 hereditary spherocytosis patients who had stones in the gallbladder. One patient was converted to the open surgery due to the bleeding which was eliminated the exposure during the dissection. At the postoperative period, we observed atelectasis in one patient, and wound fat necrosis in one patient. In addition, thrombocytosis was observed in one patient. Hematological treatment was continued because of persistent refractory thrombocytopenia in two patients, and temporary thrombocytopenia in four patients. An accessory spleen was detected with splenic scintigraphy in one of these patients at the postoperative period. The average hospitalization time was 2.6 ± 0.7 days. Conclusion: Laparoscopic splenectomy for hematological diseases may be considered as first-line therapy with less hospital stay and morbidity.

PDF

___

Katkhouda N, Hurwitz MB, Rivera RT, et al. Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 1998;228:568-578.
Barbaros U, Aksakal N, Tukenmez M, et al. Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura: Clinical comparative study. J Minim Access Surg 2015;11:172-176.
Pardhan A, Hameed A, Zafar H, Mazahir S, Murtaza G. Outcomes of splenectomy for idiopathic thrombocytopenic purpura in adults: a developing country perspective. J Pak Med Assoc 2014;64:1240-1243.
Delaitre B, Maignien B. Splenectomy by the coelioscopic approach: report of case. Presse Med 1991;20:2263.
Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190-4207.
Önder A, Kapan M, Gül M, ve ark. İdiopatik trombositopenik purpuralı hastalarda splenektomi: 109 olgununun analizi (Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases). Dicle Tıp Dergisi 2012;39:49-53.
Matharoo GS, Afthinos JN, Gibbs KE. Trends in splenectomy: where does laparoscopy stand? JSLS 2014;18:1-7 (e2014.00239).
Chen J, Ma R, Yang S, Lin S, He S, Cai X. Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis. Chin Med J (Engl) 2014;127:2504-2510.
Kathkouda N, Hurtwitz MB, Rivera RT, et al. Laparoscopic splenectomy. Outcome and efficacy in 103 consecutive cases. Ann Surg 1998;228:568-578.
Patel AG, Parker JE, Wallwork B, et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 2003;238:235-240.
1. Park AE, Birgisson G, Mastrangelo MJ, Marcaccio MJ, Witzke DB. Laparoscopic splenectomy: outcomes and lessons learned from over 200 cases. Surgery 2000 ;128:660-667.
Vecchio R, Intagliata E, Marchese S, La Corte F, Caccioa RR, Cacciola E. Laparoscopic splenectomy coupled with laparoscopic cholecystectomy. JSLS 2014;18:252-257.
Targarona EM, Espert JJ, Balague´ C, et al. Residual splenic functions after laparoscopic splenectomy: a clinical concern. Arch Surg 1998;133:5660.
Gigot JF, Jamar F, Ferrant A, et al. Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy: A shortcoming of the laparoscopic approach in hematologic diseases. Surg Endosc 1998;12:101106.
Ekmekçi Ş, Diz-Küçükkaya R, Türkmen C, Adalet I. Selective spleen scintigraphy in the evaluation of accessory spleen/splenosis in splenectomized/nonsplenectomized patients and the contribution of SPECT imaging. Mol Imaging Radionucl Ther 2015;24:1-7.
Koshenkov VP, Pahuja AK, Németh ZH, Abkin A, Carter MS. Identification of accessory spleens during laparoscopic splenectomy is superior to preoperative computed tomography for detection of accessory spleens. JSLS 2012;16:387- 391.
Quah C, Ayiomamitis GD, Shah A, Ammori BJ. Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary? Surg Endosc 2011;25:261- 265.