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A Clinical Concern

Eduard M. Targarona, MD, PhD; Joan Josep Espert, MD; Carme Balagué, MD; Gemma Sugrañes, MD; Carme Ayuso, MD, PhD; Francesc Lomeña, MD, PhD; Francesc Bosch, MD, PhD; Manuel Trias, MD, PhD

Arch Surg. 1998;133:56-60.

Objective  To document the existence of residual splenic function after laparoscopic splenectomy in a series of 48 patients.

Design  A noncomparative descriptive case series.

Setting  A tertiary care center.

Patients  A series of 9 patients without clinical improvement after laparoscopic splenectomy of 48 consecutive patients undergoing laparoscopic splenectomy for several hematologic disorders after a mean follow-up of 16 months (range, 1-40 months).

Interventions  A computed tomographic scan and technetium Tc 99m sodium pertechnetate heat-damaged red blood cell scintigraphy were performed for patients with partial (platelet count <100x10⁹/L) or total (platelet count <50x10⁹/L) failure of improvement.

Main Outcome Measure  Evidence of residual splenic tissue by image diagnosis.

Results  The condition of 9 of the 48 patients failed to improve after laparoscopic splenectomy. Six patients experienced a total failure of improvement and 3 experienced a partial failure of improvement (1 patient had human immunodeficiency virus–related thrombocytopenia and 8 had idiopathic thrombocytopenic purpura). Three patients had residual splenic function, which was revealed by scintigraphy. The results of a computed tomographic scan showed an accessory spleen in one patient and splenic implants in splenic fossa in another patient.

Conclusion  Laparoscopic splenectomy has a promising role in the management of hematologic diseases requiring splenectomy, but it requires exquisite care to avoid parenchymal rupture and cell spillage and to avoid leaving accessory spleens, which can lead to the failure of surgical treatment.

From the Services of General and Digestive Surgery (Drs Targarona, Espert, Balagué, Sugrañes, and Trias), Radiology (Dr Ayuso), and Hematology (Dr Bosch), and the Laboratory of Nuclear Medicine (Dr Lomeña), Hospital Clinic, University of Barcelona, Barcelona, Spain.