Gallstone disease is a common association in patients with haematological splenomegaly. When indicated, simultaneous splenectomy and cholecystectomy should be performed and traditionally this is accomplished by open surgery. We report a 17 year old thalassaemic girl with splenomegaly complicated by gallstone pancreatitis. We treated her with a combination of needlescopic cholecystectomy and laparoscopic splenectomy as well as delivering the huge spleen via a pfannenstiel incision to hide the scar. We believe this technique is an acceptable alternative mainly for rapid delivery of the spleen and to minimize visible scars hence improving cosmesis.
Cholecystectomy, Laparoscopic/*methods ; Cholelithiasis/etiology ; Cholelithiasis/*surgery ; Splenectomy/*methods ; Splenomegaly/etiology ; Splenomegaly/*surgery ; beta-Thalassemia/*complications

BACKGROUNDLaparoscopic splenectomy (LS) has been considered as the standard approach to remove a normal-sized spleen, but it is facing technical challenges when applied to splenomegaly. Hand-assisted laparoscopic technique was designed to facilitate the performance of difficult laparoscopic procedure. This study was aimed to evaluate the efficacy and superiority of hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.

METHODSFrom November 1994 to January 2006, 36 patients with splenomegaly (final spleen weight > 700 g) were treated with laparoscopic operations for splenectomy in our hospital. Conventional LS was performed in 16 patients (7 men and 9 women, group 1) and HALS in the other 20 patients (12 men and 8 women, group 2). The patients' features, intraoperative details and the postoperative outcomes in the both groups were compared.

RESULTSThe both groups were comparable in the terms of patient's age ((38 +/- 12) years vs (43 +/- 14)years, P > 0.05), the greatest splenic diameter ((24 +/- 5)cm vs (27 +/- 7)cm, P > 0.05), preoperative platelet count ((118 +/- 94) x 10(9)/L vs (97 +/- 81) x 10(9)/L, P > 0.05) and diagnosis. Compared with LS group, operation time ((195 +/- 71) minutes vs (141 +/- 64) minutes, P < 0.05) was shorter, intraoperative blood loss ((138 +/- 80)ml vs (86 +/- 45)ml, P < 0.05) and conversion rate (4/16 vs 0/20, P < 0.05) were lower, but hospital stay ((5.3 +/- 3.8) days vs (7.4 +/- 1.6) days, P < 0.05) was longer in HALS group. There was no significant difference in the aspects of intraoperative and postoperative complication rate (2/16 vs 0/20, P > 0.05) or recovery time of gastrointestinal function ((16.3 +/- 11.6) hours vs (18.7 +/- 8.1) hours, P > 0.05) between the two groups.

CONCLUSIONSIn the cases of splenomegaly, HALS significantly facilitates the surgical procedure and reduces the operational risk, while maintaining the advantages of conventional LS. HALS is more feasible and more effective than conventional LS for the removal of splenomegaly.

Adolescent ; Adult ; Aged ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Splenectomy ; methods ; Splenomegaly ; surgery

Adult ; Aged ; Esophageal and Gastric Varices ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; pathology ; surgery ; Pancreatic Neoplasms ; diagnosis ; surgery ; Splenomegaly ; diagnosis ; surgery ; Young Adult

BACKGROUNDLaparoscopic splenectomy (LS) for massive splenomegaly is more technically challenging than for a normal-sized spleen. The purpose of this study was to determine the effect of operative experience on perioperative outcomes of LS for massive splenomegaly.

METHODSBetween January 2008 and December 2010, 36 consecutive patients who were diagnosed with massive splenomegaly underwent LS in our department. The perioperative outcomes were evaluated for evidence of a learning curve effect. Patients were divided into three groups (1, 2, and 3) of 12 consecutive patients, and outcomes of each group were compared.

RESULTSThe mean operative time decreased significantly from 252 minutes of Group 1 to 179 minutes of Group 3. The estimated blood loss and length of post-operative hospital stay showed a similar trend. No significant differences were found in the splenic length and weight, transfusion rate, or average amount of drainage. In this cohort, there were three cases with surgical complications and one conversion to open laparotomy.

CONCLUSIONSThe first 24 cases constitute the early stage of the learning curve for LS for massive splenomegaly. LS for massive splenomegaly is a technically challenging operation with a long learning curve, and strategies for developing training programs must address these challenges.

Adult ; Female ; Humans ; Laparoscopy ; education ; Learning Curve ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Splenectomy ; adverse effects ; education ; Splenomegaly ; surgery

BACKGROUNDOrthotopic liver transplantation (OLT) has become the therapeutic option of choice for end-stage liver disease. The aim of this study was to investigate the changes of splenic morphology, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC) values and explore their value in evaluating the therapeutic effects of orthotopic liver transplantation (OLT) on portal hypertension at 1.5 Tesla MRI.

METHODSTwenty patients with portal hypertension undergoing OLT were included in this study. Conventional MRI and diffusion-weighted image (DWI) (b value = 600 s/mm(2)) sequences were applied on each patient before and after OLT, and these patients were referred to as the preoperative and postoperative groups. Twenty healthy individuals were selected as the normal group. After image acquisition, the splenic width (W), thickness (T), length (L), the diameter of the portal vein (PD) and splenic vein (SD) were measured and the splenic volume (V) was calculated. The SNR and CNR were measured on T2WI. The ADC maps were calculated using the b600 in DWIs and the ADC values were measured.

RESULTSCompared with the preoperative group, the splenic V, PD and SD decreased significantly in the postoperative group (P < 0.05). All splenic morphological values were significantly different between preoperative and normal groups (P < 0.05). The splenic L and V were significantly different (P < 0.05) between postoperative and normal groups. The SNR and CNR values were 17.66 ± 4.62 and 13.18 ± 3.12, 11.50 ± 1.64 and 7.44 ± 4.32, 4.24 ± 1.24 and 3.03 ± 2.41 in the preoperative, postoperative and normal groups, respectively. Both SNR and CNR decreased after OLT, but they was still higher than the normal values. The SNR was significantly different between any two groups (P < 0.05). The CNR was significantly different (P < 0.05) between the preoperative and postoperative groups, preoperative and normal groups. The splenic ADC values were (1.339 ± 0.482) × 10(-3) mm(2)/s, (1.120 ± 0.254) × 10(-3) mm(2)/s and (0.997 ± 0.447) × 10(-3) mm(2)/s in the preoperative, postoperative and normal groups, respectively. The difference of ADC values were significant (P < 0.05) between the preoperative and postoperative groups, and the preoperative and normal groups.

CONCLUSIONSOLT is an effective method of treatment for portal hypertension. In addition to dramatically decreasing the splenic V, it can also decrease the splenic SNR, CNR and ADC values in patients with portal hypertension. The changes of splenic SNR, CNR and ADC after OLT may be helpful in providing noninvasive supplementary information in assessing the therapeutic effect of OLT on portal hypertension.

Adult ; Aged ; Female ; Humans ; Hypertension, Portal ; diagnosis ; surgery ; Liver Transplantation ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Retrospective Studies ; Splenomegaly ; diagnosis ; surgery

PURPOSE: Laparoscopic splenectomy (LS) is the procedure of choice in treating hematologic diseases, however there are controversies concerning malignancy and splenomegaly. This study was performed in order to examine the safety and efficacy of LS and hand-assisted laparoscopic splenectomy (HALS) in the management of patients with various splenic tumors and splenomegaly. METHODS: Fifteen patients who had undergone laparoscopic splenectomy for suspected splenic tumors between May, 1998 and December, 2000 were evaluated. We conducted a review, recording previous abdominal surgery, diagnostic work up, size of spleen, accessory spleen, type of surgery, morbidity, mortality, and length of hospital stay. A retrograde analysis was conducted using the medical records of the patients. RESULTS: The average splenic length was 22.4 cm (range, 14~37 cm), and the average weight was 1,210 gm (range, 210~3,700 gm). There were two types of operations performed. LS was accomplished in 7 cases and HALS in 8 cases. All operations were completed without any conversion to open surgery. The average intraoperative blood loss was 153.5 ml (range, 45~830 ml). The average postoperative stay was 5.2 days (range, 3~9 days). Only one complication (subphrenic abscess) developed (7%), which was resolved by percutaneous drainage. No deaths occurred. The pathologic findings were lymphoma (4), hemangioma (4), islet cell tumor (2), lymphangioma (3), myelofibrosis (1), and hematoma (1). CONCLUSION: LS and HALS are safe and feasible procedures for the treatment of most neoplastic splenic diseases with splenomegaly. HALS is an alternative approach for overcoming the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis and hilar lymphadenopathy. As the indications for LS including HALS are expanded, the role of LS and HALS in various splenic tumors will become more clearly defined.
Adenoma, Islet Cell ; Conversion to Open Surgery ; Drainage ; Hemangioma ; Hematologic Diseases ; Hematoma ; Humans ; Length of Stay ; Lymphangioma ; Lymphatic Diseases ; Lymphoma ; Medical Records ; Mortality ; Primary Myelofibrosis ; Spleen ; Splenectomy* ; Splenic Diseases ; Splenomegaly

OBJECTIVETo assess the feasibility and safety of radiofrequency ablation (RFA) in spleen to treat secondary splenomegaly and hypersplenism in dogs.

METHODSFourteen healthy mongrel dogs were randomly divided into two groups: group A (n = 4) and group B (n = 10) Both groups underwent ligation of the splenic vein and its collateral branches to induce congestive splenomegaly. At the end of the 3rd week, radiofrequency thermal ablation of the spleen was performed in the group B via laparotomy. After splenic RFA, the procedure-related complications were observed, CT scan was performed and the spleens were obtained according to schedule. The radiofrequency (RF) thermal lesions and its histo- pathological changes of the spleen were examined regularly.

RESULTSThere were no morbidity and mortality in the experimental dogs. CT findings revealed that splenomegaly could sustained over 2 months after ligation of the splenic vein. The segmental RF lesions included hyperintense zone of coagulative necrosis and more extensively peripheral hypo-intense infarcted zone. The latter was called as "bystander effect". The infarcted zone would be absorbed and subsequently disappeared between 4 and 6 weeks after RFA, and the size of the remnant spleen shrunk, but the lesion of coagulative necrosis hardly altered. The fundamental histopathological changes of splenic lesions caused by RF thermal energy included local coagulative necrosis and the peripheral thrombotic infarction zone. Subsequently, tissue absorption and fibrosis occurred in the zone of thrombotic infarction. Simultaneously occluded vessels, fibrin deposition, and disappearance of normal splenic sinuses resulted in the condensed structure of the viable remnant spleen, which were the pathological basis responsible for the shrunk spleen.

CONCLUSIONSIt is feasible and safe to perform RFA in the spleen to treat experimental splenomegaly and hypersplenism. The RFA technique could be safely performed clinically via laparotomy or laparoscopic procedure to strictly isolate the spleen from the surrounding organs.

Animals ; Catheter Ablation ; Disease Models, Animal ; Dogs ; Feasibility Studies ; Female ; Hypersplenism ; etiology ; pathology ; surgery ; Ligation ; adverse effects ; Male ; Random Allocation ; Spleen ; diagnostic imaging ; pathology ; Splenectomy ; methods ; Splenic Vein ; surgery ; Splenomegaly ; etiology ; pathology ; surgery ; Tomography, X-Ray Computed

We describe moderate hyperbilirubinemia in a 28-year-old man who suffered from gallstones and splenomegaly, with combined disorders of hereditary spherocytosis (HS) and Gilbert's syndrome (GS). Since it is difficult to diagnose HS in the absence of signs of anemia, we evaluated both the genetic mutation in the UGT1A1 gene and abnormalities in the erythrocyte membrane protein; the former was heterozygous for a UGT1A1 allele with three mutations and the latter was partially deficient in ankyrin expression. This is the first report of the concomitance of HS and GS with three heterozygous mutations [T-3279G, A (TA)7TAA, and G211A] in the UGT1A1 gene.
Adult ; Alleles ; Ankyrins/metabolism ; Electrophoresis, Polyacrylamide Gel ; Gallstones/surgery ; Gilbert Disease/complications/*diagnosis/genetics ; Glucuronosyltransferase/chemistry/genetics/metabolism ; Heterozygote ; Humans ; Male ; Mutation ; Protein Structure, Tertiary ; Sequence Analysis, DNA ; Spherocytosis, Hereditary/complications/*diagnosis/genetics ; Splenomegaly/diagnosis

Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.
Adult ; Blood Loss, Surgical ; Female ; Humans ; Hypertension, Portal ; complications ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Splenectomy ; adverse effects ; methods ; Splenomegaly ; etiology ; surgery ; Vascular Surgical Procedures ; adverse effects ; methods

We report herein a case of 35-years-old woman in whom portal hypertension (esophageal varix and splenomegaly) developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for rectal cancer. She was transferred for the evaluation of etiology of new-onset portal hypertension. The esophageal varix and splenomegaly were absent before the oxaliplatin based adjuvant chemotherapy. Thorough history taking and serological exam revealed no evidence of chronic liver disease. Liver biopsy was done and there was no cirrhotic nodule formation. Instead, perivenular fibrosis was noted. Considering new development of esophageal varices and splenomegaly after 12 cycles of oxaliplatin-based adjuvant chemotherapy, we could conclude that portal hypertension in this patient were due to sinusoidal injury by oxaliplatin. Finally, we recommend regular follow-up with endoscopy and radiologic examination for checking the development of varices and for screening of varices and splenomegaly in patients with colo-rectal cancer who receive oxaliplatin-based chemotherapy.
Adult ; Antineoplastic Agents/*adverse effects/therapeutic use ; Chemotherapy, Adjuvant ; Esophageal and Gastric Varices/chemically induced ; Female ; Fibrosis ; Humans ; Hypertension, Portal/chemically induced/*diagnosis ; Liver/pathology ; Organoplatinum Compounds/*adverse effects/therapeutic use ; Positron-Emission Tomography ; Rectal Neoplasms/*drug therapy/surgery ; Splenomegaly/chemically induced ; Tomography, X-Ray Computed