Our study supports that the proposal that LS is safe and has numerous advantages, even in the case of massive splenomegaly. Our results were mainly affected by the spleen size and the learning curve.

Introduction: Aneurysm of the extracranial carotid artery is a rare condition and there is a diversity in the etiology. The proper treatment could be a real challenge for the surgeons. Aim: Analysis of perioperative and long term results of invasive treatment for carotid artery aneurysm. Method: A retrospective review was conducted of patients who had open or endovascular surgery due to carotid artery aneurysm through the last 13 years at the Department of Vascular Surgery of the Semmelweis University and at the Department of Surgery of the University of Szeged. Medical history, characteristics of the aneurysms, therapy and the follow-up results were reviewed. Results: Over the study period, 25 interventions were performed due to carotid artery aneurysm. There were 10 men and 15 women with a mean age of 57.8 ± 15.15 years. Seventeen patients (68%) were symptomatic. The mean aneurysm diameter was 26.8 ± 11.25 mm. The underlying etiology was atherosclerosis in eleven (44%), prior carotid endarterectomy in four (16%), infection in four (16%) and other cause (connective tissue disease, dissection, trauma) in six (24%) cases. Nineteen patients underwent open surgery, six underwent endovascular treatment. Death within 30 days was documented in one (4%) case. The mean postoperative hospital stay was 4.52 ± 2.38 days. Three (12%) patients required reintervention postoperatively. Peripheral nerve injuries were detected in four (16%) patients, all after open surgery. No stroke was documented within 30 days. The mean follow-up was 41.2 ± 38.54 months. Five (24%) deaths were not related to the carotid artery disease. One patient had stroke, one had transient ischaemic attack (TIA), and in two cases asymptomatic internal carotid artery occlusion was described. Conclusion: Both open surgery and endovascular intervention can be safely applied in the treatment of carotid artery aneurysm. Considering the variable etiology and rarity, we recommend to perform the interventions in vascular surgery centres. Orv Hetil. 2019; 160(21): 815–821.

Our study proves that laparoscopic splenectomy is a safe method with many advantages. Our results correlate with data of international publications.

Background and Objectives:Therapy-resistant immune thrombocytopenia (ITP) is the most frequent indication of laparoscopic splenectomy (LS). It ensures the best results for this disease compared with possible second-line pharmacologic therapies. Therefore, learning about the safety of the surgical method and its long-term efficacy is important, as is selecting patients who respond to surgical treatment. Our purpose was to analyze the safety of LS and the short-and long-term prognostic significance of known perioperative parameters.Methods:We performed 40 LSs for ITP from January 1, 2000, to January 1, 2015. We analyzed the roles of the perioperative parameters by using evidence-based guidelines.Results:Complete response (CR; platelet count over 100 × 109/L) occurred in 28 cases (70%) and partial response (PR; platelet count between 30 and 100 × 109/L) in 5 cases (12.5%). Below the age of 50, 9% (2/22) of the patients had no response (NR; platelet count not increasing over 30 × 109/L), 28% (5/18) over the age of 50 (P = .023) had no response. In the steroid-refractory group, 30% did not respond, whereas 100% of the steroid-dependent patients had a CR (NR: 7/23 steroid refractory vs 0/17 steroid dependent; P = .027). The patients were followed up for a mean of 10.9 ± 6.9 years, and a long-term response (LTR) was detected in 21 of the responders (n = 33). Of the patients who originally had a CR, 71% also achieved LTR, whereas only 20% of the PR patients did.Conclusion:LS is safe and remains the most effective second-line treatment for ITP. In our study, younger age and response to preoperative steroids were predictive factors for the long-term success of splenectomy.

Our study supports that laparoscopic splenectomy is safe and has numerous advantages even in the case of massive splenomegaly. The retrieval of the specimen through a Pfannenstiel incision is considered a safe and cosmetically acceptable alternative.