Abstract:LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss. Besides, total postoperative complications may be slightly lower in LS. We conclude that LS should be considered an acceptable option for children.
“…Also vascular embolization, when an independent vascular pedicle is found, can be used [16]. The choice for surgical approach is surely influenced by the attitude of the operating surgeon toward minimally invasive techniques such as laparoscopy or robotic surgery (which are nowadays considered as the gold standard in uncomplicated cases) or open technique [17]. In our patient, recurrent abdominal pain was probably due to short lasting ischemia caused by intermittent torsion-detorsion which was possible for the incomplete fixation of the spleen to the gastrosplenic and splenorenal ligaments and for a longer vascular pedicle [18].…”
Accessory spleen (AS) is a condition found in about 20% of patients and is most commonly located in the hilar region of the spleen. It is more often asymptomatic, single, and smaller than 2 cm. In the present study, we report the rare case of a 13-year-old boy with giant accessory spleen underwent spontaneous intrasplenic hemorrhage who presented with recurrent abdominal pain. Contrast-enhanced MRI was mandatory for the diagnosis before surgical procedure.
“…Also vascular embolization, when an independent vascular pedicle is found, can be used [16]. The choice for surgical approach is surely influenced by the attitude of the operating surgeon toward minimally invasive techniques such as laparoscopy or robotic surgery (which are nowadays considered as the gold standard in uncomplicated cases) or open technique [17]. In our patient, recurrent abdominal pain was probably due to short lasting ischemia caused by intermittent torsion-detorsion which was possible for the incomplete fixation of the spleen to the gastrosplenic and splenorenal ligaments and for a longer vascular pedicle [18].…”
Accessory spleen (AS) is a condition found in about 20% of patients and is most commonly located in the hilar region of the spleen. It is more often asymptomatic, single, and smaller than 2 cm. In the present study, we report the rare case of a 13-year-old boy with giant accessory spleen underwent spontaneous intrasplenic hemorrhage who presented with recurrent abdominal pain. Contrast-enhanced MRI was mandatory for the diagnosis before surgical procedure.
“…Feng ve ark. (13) 992 çocuk hasta, 508 laparoskopik, 414 açık splenektominin dahil edildiği bir metaanalizde açık ve laparoskopik splenektomileri kıyas-lamış, laparoskopik splenektomiyi kısa yatış süresi, daha az kan kaybı açısından üstün bulmuştur. Postoperatif komplikasyon oranı ve aksesuar dalak tespiti açısından ikisi arasında fark görmemişlerdir.…”
Öz
GirişLaparoskopik splenektomi ilk kez Delaitre ve ark.(1) tarafından 1991 yılında erişkinde gerçekleştirilmiştir. Çocukluk çağında ilk laparoskopik splenektomi ise 1993 yılında Tulman ve ark.(2) tarafından yapılmış-tır. Yıllar içinde çocuk hastada dalağın laparoskopik olarak çıkarılması her geçen gün tercih edilebilen bir yöntem olmuştur. Laparoskopik splenektomi açık splenektomiye göre kozmetik olarak üstünlüğünün yanında immünolojik yanıt olarak da üstündür (3) . Ço-cuk cerrahları dalağa yönelik minimal invaziv cerrahiye temkinli yaklaşmışlardır. Bunun nedeni çocuk hastalarda daha küçük karın içi alanda büyük organların laparoskopik çıkarımının zor olduğu ve risk taşıdığı düşüncesidir. Aynı zamanda çocukluk çağında dalağa yönelik girişimler kıyasla azdır, tecrübe erişkin cerrahisine göre daha geç kazanılmaktadır. Laparoskopik splenektomi kısalmış hastanede kalış süresi, düşük perioperatif morbidite, erken beslenme, fiziksel aktiviteye daha hızlı dönüş, yaşam kalitesinde artış gibi minimal invaziv cerrahinin avantajlarını taşımakta-dır. Daha ince aletlerin üretimi, teknolojinin gelişimi ve tecrübenin artması ile dalağın laparoskopik çıka-rılması altın standart olmuştur (4) . Minimal invaziv splenektomi günümüzde, el yardımlı laparoskopik splenektomi, NOTES (natural orifice transluminal endoscopic surgery), robot yardımlı splenektomi, ve tek port splenektomi şeklinde de yapılmaktadır (5)(6)(7)(8)(9)(10)(11)(12) .
Dalak anatomisiDalağın medialinde mide ve pankreas kuyruğu, önün-de kolonun splenik fleksurası, arkasında sol sürrenal bez ve sol böbreğin üst polü mevcuttur. Dalak, gastrosplenik, splenofrenik ve splenokolik bağlar ile kendi lokalizasyonuna tespit edilmiş durumdadır (Şekil 1). Splenik arter, çölyak arterin bir dalıdır. Dalak hilusuna ulaşan splenik arter, splenorenal ligament içine, çoğu insanda alt ve üst kutuplara giden iki, az kişide de üç lobuler dala ayrılır; lobuler dalların her biri de dalak içinde trabekülleri izleyerek 3-8 adet, birbiriyle ilişki-si olmayan segmenter dallar halinde dağılır. Bu anatomik yapı parsiyel splenektomiye de olanak sağlar.
Endikasyonları
Laparoskopik splenektominin endikasyonları genelAlındığı tarih: 07.03.2016
“…However, because remissions of ITP in children are often delayed and children <5 years of age are more susceptible to fatal sepsis caused by encapsulated organisms such as Streptococcus pneumoniae , Hemophilus influenza type b, and Neisseria meningitidis , the 2011 ASH guidelines recommended splenectomy to be considered for children with chronic ITP and who had bleeding symptoms [ 3 ]. Due to shorter hospital stay and less blood loss, laparoscopic splenectomy is preferred over open splenectomy in children with chronic ITP [ 55 ]. Children should complete vaccinations for encapsulated organisms at least 2 weeks prior to splenectomy, and prophylactic antibiotics are required for 2 years after splenectomy.…”
Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.
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