Incidence, risk factors, and outcome of portal vein thrombosis after laparoscopic-assisted splenectomy in ß-thalassemia patients: a prospective exploratory study.

BACKGROUND: Portal vein system thrombosis (PVT) is an infrequent but potentially serious complication after laparoscopic splenectomy. Patients with ß-thalassemia are at higher risk as they have splenomegaly and hypercoagulability. SUBJECTS AND METHODS: Forty-eight ß-thalassemia patients who underwent hand-assisted laparoscopic splenectomy or laparoscopic splenectomy were studied prospectively with pre- and postoperative Doppler ultrasonography or computed tomography scanning. RESULTS: The incidence of PVT was 8.3% (95% confidence interval [CI] 0.2%-16.4%) (4 of 48 patients). Spleen weight was the only independent factor associated with the presence of PVT. The odds ratio for spleen weight (100 g increase) was 1.46 (95% CI 1.10-1.94, P=.010). Receiver operator characteristic curve analysis showed that the optimal cutoff of spleen weight to the prediction of PVT was 1543 g. Thrombosis resolution was observed after a median of 165 days. CONCLUSIONS: Patients with ß-thalassemia who undergo laparoscopic-assisted splenectomy are at high risk of postoperative PVT. Close postoperative surveillance and aggressive coagulation prophylaxis are needed in these patients. Larger studies are required to confirm the present findings.

Laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstone disease.

BACKGROUND: The aim of this study was to evaluate the outcome in patients with liver cirrhosis who underwent laparoscopic cholecystectomy for symptomatic gallstone disease. METHODS: Retrospective analysis of prospectively collected data of 34 patients operated between March 1998 and April 2006. RESULTS: There were 19 male and 15 female patients with a median age of 62 years. Cirrhosis aetiology was viral hepatitis in 25 patients, alcohol in 6, primary biliary cirrhosis in 2 and in 1 patient the cause was not identified. Twenty-three were classified as Child-Pugh-Turcotte stage A and 11 as Child-Pugh-Turcotte stage B. The median Model For End-Stage Liver Disease score was 12. Median operating time was 96 min. In three patients there was conversion to open cholecystectomy. Postoperatively, one patient died and six more patients had complications. Median postoperative stay was 3 days. Patients with acute cholecystitis did not have increased morbidity, but had significantly longer hospital stay. CONCLUSION: Laparoscopic cholecystectomy can be carried out with acceptable morbidity in selected patients with well-compensated Child A and B stages liver cirrhosis. Patients with evidence of significant portal hypertension and severe coagulopathy should avoid surgery.

Outcome analysis of laparoscopic cholecystectomy in patients aged 80 years and older with complicated gallstone disease.

BACKGROUND: The aim of this study was to evaluate the outcome of laparoscopic cholecystectomy (LC) in octogenarians with complicated gallstone disease. MATERIALS AND METHODS: This study was a retrospective analysis of prospectively collected data of 51 patients aged 80 years or older who underwent an LC for complicated gallstone disease between 2001 and 2006. This group was compared with 41 octogenarian patients with uncomplicated gallstone disease. RESULTS: There were 51 patients (26 men) with a median (range) age of 87 years (range, 80-93) who underwent an LC for complicated biliary disease, including acute cholecystitis in 29 (57%), gallstone pancreatitis in 14 (27%), cholangitis in 4 (7.8%), and obstructive jaundice in 4 (7.8%). Significantly more patients in the complicated disease group underwent preoperative endoscopic retrograde cholangiopancreatography (33.3% vs. 12.1%; P = 0.026) The median operative time was 110 minutes (range, 55-165) and this was significantly longer, compared to the uncomplicated disease group (P = 0.031). Postoperative morbidity was 27.3%, a significantly higher rate, compared to the uncomplicated group (27.4% vs. 7.3%; P = 0.015) with zero mortality. The conversion rate was 7.8% and this was not significantly different from the uncomplicated disease group. The median length of hospital stay was 6 days, which was significantly longer than the uncomplicated disease group (P = 0.021). CONCLUSIONS: The LC can be performed with acceptable morbidity in octogenarians with complicated gallstone disease. Early treatment of gallstone disease in this age group could further improve outcomes.

Splenic abscess in a patient with Wegener's granulomatosis treated with laparoscopic splenectomy.

Splenic abscess complicating Wegener's granulomatosis (WG) has not been previously described. We report the occurrence of a splenic abscess in a 45-year-old white male suffering from WG. The patient presented with persistent fever and abdominal pain. Magnetic resonance imaging showed two splenic cystic lesions. Differential diagnosis was splenic hematoma or abscess. The patient underwent diagnostic laparoscopy and laparoscopic splenectomy. Pathology revealed a centrally located cavity full of pus and necrotic material. Although there were no signs of active vasculitis, all other histological features were compatible with WG. The patient had an uneventful postoperative course and his disease is in remission. Laparoscopic splenectomy appears to be a safe procedure, but its impact on the management of splenic abscess needs to be determined further.