Esplenectomía Laposcópica, ¿es la técnica ideal?

Abstract

Background: At the beginning of the last decade, different groups of workers developed almost simultaneously the laparoscopic splenectomy technique. From then on, and based on the accumulated experience done in the fleld, this technique has become the preferred approach. Objetives: to analyze the results obtained with laparoscopic splenectomy on 29 patients with various pathologies. Location: General Surgery Service N°2, Prof. Pablo Mirizzi, Clinic National Hospital. General Surgery Service, Sucre Clinic, Córdoba. Design: prospective study. Materials and Methods: Twenty-nine laparoscopic splenectomies were indicated in 22 cases of idiopatic thrombocytopenic purpura.

4 autoimmune hemolytic anemia, two spheroid and one segmental hypertension portal. A simultaneous prophylactic cholecistectomy vas perl'ormed in cases of malign spheroicl associated with cholelitiasis. Cases of incorrigible coagulopaty, ascitis and spleenomegaly , greater than 30 cm., were discarded. Antibiotic prophylaxis, bovine anhi-pneumonic vaccine, drainage to the spleen cavity, precocious mobilization and liquid diet starting at 6 am. werc systematically indicated. Results: there was no mortality and a patient with spleenomegaly of 28 cm. was converted (3.4%). The average surgical time was 90 minutes. In 4 cases (13.7%) of patients with ITP, accessory spleens wcre found. No patient was transfused whcn bleeding was less than approximiately 100cm. The rnain surgical difficulty vas the spleen mobilization at the level of the pedicle in the big spleens and Ihe hemorrhaging in small volumes during the dissection. Conclusion: this tcchníque offers a series of advantages that allow it to be considered as Ihe new "goid standard' for splcnectom.v.