Consecutive Concomitant Laparoscopic Splenectomy and Cholecystectomy: An Italian Experience of 30 Patients and Proposition of a Technique

Abstract

With increasing institutional experience, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases. The four-trocar technique guarantees good results.

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

“…Relative indications are: primarily unresponsiveness to medical therapy, disease relapse, splenomegaly, transfusion dependence, steroid dependency and intolerance or adverse side effects of steroid therapy (2,. In cases of concurrent symptomatic and asymptomatic non-complicated gallbladder lithiasis and benign hematological disorder, LS with concomitant laparoscopic cholecystectomy have been proposed as safe and feasible with acceptable operative time, conversion and transfusion rates and postoperative results (6,17,19).…”

“…Depending on each study's methodology, the mean operative time was reported as being between 75 and 162 min, (6,7,9,10,13,14,25,44), the mean operative time between 150 and 165 min (17,19) and the median operative time between 109 and 144 min (18,20). However, splenomegaly (7), low platelet count (9), anterior approach (10), indications other than immune thrombocytopenic purpura (ITP) (18,20) and concomitant laparoscopic cholecystectomy (18,20), significantly prolonged the operative time.…”

“…LS can be performed with minimal blood loss (mean 36-60 ml) (6,13,17,19,25) and significantly less blood loss compared to OS (14). In the study of Vecchio et al, platelet transfusion was occasionally required (1 out of 12 patients) (6); in other studies, the need for packed erythrocyte transfusion was rare (9, 10), while intraoperative blood loss of more than 600 ml (9), as well as the anterior approach (10), almost always lead to packed erythrocyte transfusion.…”

“…Encountering the hand-assisted technique as a modification of LS, literature reports a very low conversion rate to OS, varying between 0 and 4% (6,7,9,10,14,17,19). In order of frequency, intraoperative bleeding (9,10,14), splenomegaly (11,17), anterior approach (10) and surgeon's inexperience (10) constitute the main predisposing factors for conversion.…”

“…The postoperative complications rate varied from 0% to 35.7% (6,9,10,14,18,(45)(46)(47)(48)(49). Postoperative complications include bleeding (12,17), PVT (12,19,21), subphrenic abscess formation (13,21), intestinal ischemia (40), pancreatic leakage (9), wound infections and respiratory complications (13). The reoperation rates varied from 0% to 6.7% (6-14, 17, 18, 20, 25, 27, 35, 36, 53).…”