Splenic rupture is a frequent consequence of blunt abdominal trauma. When nonsurgical management is not indicated, splenic rupture is usually an emergency requiring surgery. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorraphy, partial splenectomy, and hemostatic collagen application) are surgical treatment options. Recently, laparoscopic conservative techniques have been proposed. Laparoscopic splenectomy for a ruptured spleen has been reported only in a single case, in which a hand-assisted technique was used. We present the first reported case, to our knowledge, of successful removal of a ruptured spleen by means of a totally laparoscopic technique. Adequate technical instrumentation, such as the endostapler, harmonic scalpel, and red cell-saving machine, in addition to extensive experience with routine splenectomy, were essential factors to ensure a safe and effective procedure.
During a 4-year period (November 1990-September 1994), 1152 patients underwent laparoscopic cholecystectomy (LC). In five (0.4%) patients a cholecysto-choledochal fistula (Mirizzi's syndrome type II) was diagnosed and a minimally invasive treatment (endoscopy-laparoscopy-interventional radiology) was attempted. The first two cases were converted to open surgery probably because of severe anatomical distortion and inadequate confidence in performing a laparoscopic choledochal repair. The last three patients were successfully treated by minimally invasive procedures. These data indicate that a minimally invasive treatment can be safely attempted through a multi-disciplinary approach in Mirizzi's syndrome.
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