The laparoscopic treatment of large paraesophageal and mixed hiatal hernias is not only feasible and safe but also offers a good quality of life on a midterm basis. However, the anatomic and functional recurrence rate is high. The next step is to identify the subset of patients who are at risk of failure and to establish technical alternatives that would ensure the durability of the repair.
LS offers advantages for all types of splenic diseases requiring surgery. It provides not only good clinical short-term outcome but also satisfactory long-term hematological results.
Hypothesis: Analysis of the type and characteristics of complications after laparoscopic splenectomy may permit the identification of clinical factors with predictive value for the development of complications. Design: Univariate and multivariate analysis of factors related to complications in a prospective series of laparoscopic splenectomies. Setting: A large tertiary referral university-teaching general hospital. Patients: One hundred twenty-two nonselected consecutive patients, in whom laparoscopic splenectomy was attempted between February 1993 and July 1999. Intervention: Laparoscopic splenectomy. Main Outcome Measures: Immediate complications classified according to the Clavien score. Univariate and multivariate analyses were performed of complications related to age, sex, body mass index, and malignant nature of the hematologic disease; preoperative hematocrit and platelet count; operative time; operative position; need of accessory incision; transfusion status; learning curve; and existence of comorbid diseases. Clinical Outcome Value* Operative time, min 153 ± 59 (60-240) Transfusion, % 18 Morbidity, % 18 Hospital stay, d 4 ± 2 (2-14) Spleen weight, g 493 ± 588 (60-3200) Accessory spleen, % 12 Accessory incision, % 36 *Data are given as mean ± SD (range) unless otherwise indicated. No conversions were related to intraoperative complications. Twenty
LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a long-term hematological response comparable to the standard results that have been observed in open series.
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