Laparoscopic Splenectomy Is a Safe Method in Cases of Extremely Large Spleens

Nyilas, Áron; Paszt, Attila; Simonka, Zsolt; Ábrahám, Szabolcs; Borda, Bernadett; Mán, Eszter; Lázár, György

doi:10.1089/lap.2014.0615

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…8 Although BMI was slightly higher in the LSM group, the good results obtained indicate that the choice of the patient candidate for LS in case of massive splenomegaly also depends on other factors besides BMI. We agree with some Vecchio et al, 15 Tsamalaidze et al, 16 Nyilas et al, 17 stating that a dimensional cut-off of the spleen as the only parameter is insufficient to define the ideal candidate for a laparoscopic approach. A preoperative clinical examination to assess the abdominal "working space" in case of a laparoscopic access is of capital importance.…”

Section: Discussionsupporting

confidence: 90%

“…Contrary to the 2008 EAES guidelines on LS, most AA, thanks to the good experience gained in the following years, recommend LS for splenomegaly, regardless of spleen size. 13,22,23 More recently, Nyilas et al 17 and Vecchio et al 15 outlined that LS in massive and giant spleens is still considered a challenging procedure, and it should be reserved for specialized centers, as the most important factor of the successful procedure, besides spleen size, is possibly the experience of the team.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines?

Casaccia

Sormani²,

Palombo

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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The objective of this study was to derive some useful parameters to define the feasibility of laparoscopic splenectomy (LS) in massive [spleen longitudinal diameter (SLD) > 20 cm] and giant spleens (SLD > 25 cm). Between December 1996 and May 2017, 175 patients underwent an elective splenectomy. A laparoscopic approach was used in 133 (76%) patients. Massive spleens were treated in 65 (37.1%) patients, of which 24 were treated laparoscopically. In this subset of massive spleens, the results of laparoscopic splenectomy in massive spleens (LSM) and open splenectomy in massive spleens (OSM) were compared. The clinical outcome of a subgroup of patients with giant spleens was also analyzed. The LSM group resulted in significant longer operative times (143 ± 31 vs. 112 ± 40 min; P = 0.001), less blood loss (278 ± 302 vs. 575 ± 583 mL; P = 0.007), and shorter hospital stay (6 ± 3 vs. 9 ± 4 d; P = 0.004). No conversions were experienced in the LSM group, and the morbidity rate was similar in both the LSM and OSM groups (16.6% vs. 20%; P = 0.75). When considering the subset of 9 LSM patients and 26 OSM patients with giant spleens, the same favorable tendency of the laparoscopic group as regards surgical conversion, blood loss, and hospital stay was maintained. The laparoscopic approach can be successfully proposed in the presence of massive splenomegaly also after a careful preoperative evaluation of the expected abdominal "working space." In experienced hands, LS is safe, feasible, and associated with better outcomes than open splenectomy for the treatment of massive and giant spleen, with a maximum SLD limit of 31 cm.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines?

Casaccia

Sormani²,

Palombo

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“… 3 The main limitation of the laparoscopic technique is splenomegaly (a spleen weighing over 500 g), although our previous results showed that laparoscopic splenectomy was not contraindicated, even in the case of extreme splenomegaly (a spleen weighing over 2000 g). 14 Splenomegaly causing technical difficulties is not characteristic of ITP; therefore, this limiting factor is not common either.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Success of Laparoscopic Splenectomy for ITP

Nyilas¹,

Paszt²,

Borda³

et al. 2018

JSLS

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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.

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“…A nyitott és a laparoszkópos módszer között nem volt szignifikáns különbség sem a műtéti idő (122 vs. 133 perc, A II. vizsgálatban a 2002. január 1. és 2013. december 31. között végzett 70 laparoszkópos splenectomia eredményeit elemeztük a tanulási periódus (első 20 műtét) szerepe, a hiláris érképletek elzárásának módja (stapler vs. klipp), a léptömeg jelentősége, valamint a specimeneltávolítás módjának szerepe (Endobag þ morcelláció vs. Pfannenstielmetszés) tekintetében [3].…”

Section: Laparoszkópos Splenectomia: Műtéti Előkészítés Sebészi Technikaunclassified

Laparoszkópos lépsebészet a szegedi Sebészeti Klinikán

Nyilas

Paszt

Simonka

et al. 2022

MaSeb

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A laparoszkópos splenectomia 1991-es bevezetése óta gold standard módszer a lép sebészetében, és előnyei vitathatatlanná váltak a nyitott műtéttel szemben. A technika 1994-ben került bevezetésre a Szegedi Tudományegyetem Sebészeti Klinikáján, és az azóta eltelt időben munkacsoportunk szerezte az egyik legnagyobb tapasztalatot ezen a területen Magyarországon. Eredményeink az irodalmi adatokkal korrelálva alátámasztják, hogy a laparoszkópos lépeltávolítás biztonságos, és számos előnnyel jár a szükséges sebészi tapasztalat megszerzését követően. Vizsgálatunk során a bélpasszázs hamarabb indult be, és a hospitalizáció is rövidebb volt laparoszkópos műtétet követően. Igazoltuk, hogy a laparoszkópos splenectomia biztonságos módszer extrém nagy lépek esetében is, a lép eltávolítására a Pfannenstiel-metszés kozmetikailag is kiváló alternatíva. Habár számos új gyógyszer áll rendelkezésre az ITP második vonalbeli terápiájára, a laparoszkópos lépeltávolítás biztosítja a legtartósabb eredményeket. Saját retrospektív vizsgálatunkban mind a fiatal életkor, mind a preoperatív szteroidra adott válasz (szteroid dependens esetek), mind a perioperatív thrombocytaszám pozitív prediktív faktora volt a splenectomia hosszú távú sikerességének. Megfigyelésünk szerint a splenectomiára adott azonnali komplett válasz esetén a relapszus szignifikánsan ritkábban jelent meg.

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Laparoscopic Splenectomy Is a Safe Method in Cases of Extremely Large Spleens

Abstract: 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.

Cited by 8 publications

References 28 publications

Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines?

Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines?

Predictive Factors for Success of Laparoscopic Splenectomy for ITP

Laparoszkópos lépsebészet a szegedi Sebészeti Klinikán

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