Results of laparoscopic splenectomy for immune thrombocytopenic purpura.

OBJECTIVE: To study the safety and efficacy of Laparoscopic Splenectomy (LS) for Immune Thrombocytopenic Purpura (ITP). MATERIAL AND METHOD: Twenty-five consecutive adult patients with chronic ITP who did not achieve sustained remission or refractory to medical treatment underwent elective LS between March 1995 and July 2005. The perioperative course was documented and the follow up data were recorded. RESULTS: All 25 patients underwent successful LS by a single surgeon. Twenty patients were available to analyze with a median follow-up time of 739 days (range, 18-3,555). The mean age was 29.8 years (range, 15-44) and 17 patients were female. The median preoperative platetlet count was 16,500/microL (range, 2,000-180,000). Accessory Spleens (AS) were removed in three patients (15%). A female patient died 24 days after LS from fungal brain abscesses. Fifteen patients (75%) had platelet count > 100,000/microL at initial response. Thirteen patients (65%) are in Complete Remission (CR) (platelet count > 100,000/microL). The probability of staying in CR after LS was 60.2% by Kaplan-Meier analysis. All failures occurred within 218 days of the operation. The mean age of the patients with CR was 27.2 years (range, 15-43) while the mean age of the nonCR was 34.7 years (range, 21-44). CONCLUSION: LS should be considered as a safe and effective therapy when elective splenectomy is indicated for chronic ITP patients.

Bile duct injuries during laparoscopic cholecystectomy: an audit of 1522 cases.

BACKGROUND/AIMS: Bile duct injuries during laparoscopic cholecystectomy are serious complications. The incidence of this complication increases compared with open cholecystectomy. The aim of this paper has been to audit the incidence and nature of bile duct injuries during laparoscopic cholecystectomy in a single center. METHODOLOGY: From January 1991 to September 2000, all laparoscopic cholecystectomy attempts performed in Rajavithi Hospital were analyzed. RESULTS: Of the 1522 procedures performed, there were 9 (0.59%) cases of bile duct injuries. These involved the common hepatic duct (n=3) and the common bile duct (n=6). The underlying gallbladder pathology included chronic cholecystitis (n=6), Mirizzi's syndrome (n=2), and acute cholecystitis (n=1). Transection of the duct accounted for the majority of the injuries. Six bile duct injuries were identified at the time of operation. These were primarily repaired by direct suture (n=1) or by a biliary-enteric anastomosis (n=5). In the remaining three patients, the diagnosis was delayed. Two patients presented with a large amount of bile from the drain after surgery and one patient presented with jaundice. These were repaired by direct suture over a T tube (n=1) or biliary-enteric anastomosis (n=2). One patient developed recurrent cholangitis following biliary-enteric anastomosis after delayed diagnosis. CONCLUSIONS: The experience of a 0.59% incidence of bile duct injury is comparable to the best results from most large series in the West. Inflammation/adhesion at Calot's triangle is an important associated factor for injury. Injuries identified and repaired at the time of the first operation afford good results.