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Laparoscopic partial splenectomy: Is it possible? What is it for?

Isabelle Lacreuse, François Becmeur, Raphael Moog, Clémence Klippel, Valérie Flaum, Anne Schneider

Hôpitaux Universitaires de Strasbourg, Strasbourg, France



Context: The risk of severe infections for youngest children and the risk of thromboembolic events for oldest children after total splenectomy, make a partial splenectomy a good indication when possible.

Aim: To review the indications and to analyse our results after laparoscopic partial splenectomy

Patients and Methods: The data of all cases of LPS during the 15 last years were reviewed

Results: In the same period we performed 77 laparoscopic total splenectomies mostly for haematological diseases. Seventeen laparoscopic partial splenectomies were performed in 8 boys and 9 girls aged from 5 to 14 years-old (median: 9). Five LPS were offered for spherocytosis and one for hemoglobinosis E. A subtotal splenectomy was done. For these patients, the mean follow-up is 6.5 years (from 2 to 10 years). At the moment, any patients needs we complete splenectomy. Two LPS were done for an angioma. Nine LPS were done for a splenic cyst ranked from 10 to 17 cm (median: 12). Mean operative time was 110 minutes. There were no conversion. Blood loss was under 2g Hb, no transfusion was necessary. Mean hospital saty was 8 days, in order to overcome any secondary bleeding.

Discussion: The procedure depends on the indication: in case of splenic cyst it is necessary to remove all the cyst and the pericyst; in case of splenic tumor, the aim of the surgery is to remove the part of the spleen which contains the tumor; in case of haematological disease a subtotal splenectomy (70% or more) is required. Otherwise insufficient reduction in hemolytic rate makes the partial splenectomy useless and the risk of cholelithiasis remains.

Conclusion: LPS is feasable and safe. The aim of this surgery is significantly different according to the indication.