Laparoscopic splenectomy in patients under the age of eighteen. Experience in 18 cases.

BACKGROUND: Pediatric surgery is now in the forefront of minimal access procedures. Although pediatric surgeons have been skeptic about laparoscopic splenectomy, recently minimally invasive approach for spleen removal has been revaluated also in young patients. Purpose of this study was to report Authors' personal experience in patients under eighteen who underwent laparoscopic splenectomy. Results of the procedure were evaluated. PATIENTS AND METHODS: A retrospective review was undertaken in 18 splenectomised patients under the age of eighteen. Indications were hereditary spherocytosis in 10 patients, ß-thalassemia in 4, idiopathic thrombocytopenic purpura in 3 and a splenic cyst in 1 child. RESULTS: No intra-operative complications occurred. No conversion to open surgery was reported. During the follow-up one case of portal vein thrombosis, treated by medical therapy, was encountered and no other postoperative complications were observed. CONCLUSIONS: Laparoscopic approach has to be preferable for all those children undergoing spleen surgery. In experienced hands, it is of beneficial effects with a very reasonable rate of complications.

Laparoscopic left colectomy: from the perfect knowledge of surgical anatomy to the proper surgical technique.

Laparoscopic colo-rectal surgery has been increasingly accepted and performed in several surgical centres. However, there are still concerns about the intra-operative risks and therefore on the safety of the procedure especially during the learning curve. As a matter of fact, in approximately one third of laparoscopic colo-rectal procedures, an intra-operative complication, mainly bleeding or iatrogenic injuries, may occur. In this paper, according to our experience, we analyse step by step the surgical technique of the laparoscopic left colectomy and evaluate the technical difficulties and complications in order to avoid them.

How to prevent intraoperative risks and complications in laparoscopic splenectomy.

Since its introduction in 1992 laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen in several centres. The procedure, however, is associated with risks and complications, either during surgery or in the postoperative phase. Although the incidence of intraoperative complications is unknown, intraoperative risks in patients undergoing laparoscopic splenectomy are not uncommon. In this article, we reviewed the literature on risks and complications during LS, and we point out, based on our personal series and on the experiences reported by other Authors, how to prevent, whenever possible, these complications.