BACKGROUND/ PURPOSE: Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS. METHODS: A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay. RESULTS: All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy. CONCLUSION: Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy. Copyright 2010 Elsevier Inc. All rights reserved.
BACKGROUND/ PURPOSE: Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS. METHODS: A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay. RESULTS: All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy. CONCLUSION: Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy. Copyright 2010 Elsevier Inc. All rights reserved.
Authors: Henry E Rice; Brian R Englum; Jennifer Rothman; Sarah Leonard; Audra Reiter; Courtney Thornburg; Mary Brindle; Nicola Wright; Matthew M Heeney; Charles Smithers; Rebeccah L Brown; Theodosia Kalfa; Jacob C Langer; Michaela Cada; Keith T Oldham; J Paul Scott; Shawn St Peter; Mukta Sharma; Andrew M Davidoff; Kerri Nottage; Kathryn Bernabe; David B Wilson; Sanjeev Dutta; Bertil Glader; Shelley E Crary; Melvin S Dassinger; Levette Dunbar; Saleem Islam; Manjusha Kumar; Fred Rescorla; Steve Bruch; Andrew Campbell; Mary Austin; Robert Sidonio; Martin L Blakely Journal: Am J Hematol Date: 2014-11-24 Impact factor: 10.047
Authors: Sofia Mouttalib; Henry E Rice; Denise Snyder; Justin S Levens; Audra Reiter; Pauline Soler; Jennifer A Rothman; Courtney D Thornburg Journal: Pediatr Blood Cancer Date: 2012-01-11 Impact factor: 3.167