[Can videolaparoscopic access be used as routine in splenectomies?].

BACKGROUND

Laparoscopic splenectomy is an alternative for the treatment of patients undergoing elective splenectomy. One of its main indications is in hematologic diseases non-responsive to pharmacological treatment. Videolaparoscopy presents advantages to patients when compared to laparotomy: less post-operative pain, recovery of the functions of the gastrointestinal tract, better cosmetic results and shorter hospitalization.

AIM: To present a case series of laparoscopic splenectomy in a university hospital.

METHODS

Were analyzed all the laparoscopic splenectomies between June 2005 and October 2012. The analysis was conducted prospectively divided into pre-, trans-, and post-operative data on: gender, age, indication for surgery, rate of conversion to open surgery, duration of surgery, spleen size, presence of an accessory spleen, time hospitalization and short-term response in eight weeks after the procedure, by analyzing hemoglobin and platelets pre- and post-operative, broken down by gender.

RESULTS

Were analyzed 44 laparoscopic splenectomies performed in the period. Patients diagnosed with idiopathic thrombocytopenic purpura accounted for 56.8%, non-responsive to pharmacological treatment; autoimmune hemolytic anemia was 13.6%; spherocytosis, 11.3% and 18.3% by other non-hemolytic causes. Six patients had to be converted to open surgery (13.63%), four due to excessive bleeding. The mean operative time was 166.7 (60-319) minutes and the length of hospitalization was 12 days. Only four patients (9.1%) had post-operative complications, and none had bleeding after surgery and the positive response in the short term, after eight weeks of treatment, was achieved by 88% of patients.

CONCLUSIONS

Laparoscopic splenectomy is a safe alternative for all major indications of splenectomy and can be routinely used.