Abstract

Introduction: Laparoscopic splenectomy (LS) was first described by Delaitre in 1992. Since then it has become a popular treatment for benign diseases. It is considered preferred surgical procedure in cases where spleen size is normal. Its use in cases with hematological disorders like thalassemia, sickle cell disease and idiopathic thrombocytopenic purpura has not been extensively studied. In our region where haemoglobinopathies are prevalent in tribals and some communities like kachis, Sindhis and lohanas the eventuality that a patient will require splenectomy is fairly common. These patients (Specially patients with Beta thalassemia major) usually have grossly enlarged spleen which becomes a site for RBC sequestration and consequently there is increase frequency for transfusion required to maintain hemoglobin at a normal level. The utility of LS in these patients had been controversial and in fact grossly enlarged spleen has been considered a contraindication to LS by many authors. With increased experience of surgeons and improvements in laparoscopic technique more and more patients with haemoglobinopathies are being operated with laparoscopic techniques. We conducted this prospective study to know role of LS in patients with various hematological disorders.

Aims And Objectives: To study the indications, feasibility, safety, technical difficulties, intraoperative complications, postoperative course and outcome following elective laparoscopic splenectomy in patients with hematological disorders.

Methods and Methods: This was a prospective study conducted at a tertiary care hospital of an urban area. The study was approved by institutional ethical committee. In Our institute 32 patients underwent laparoscopic splenectomy over a period of 2 years. The records of 32 patients were evaluated for age, gender, length of hospital stay, time to resume normal diet, conversion rate, operation time and post-operative course. All patients were operated in same institute. The indication for splenectomy included hypersplenism, increased frequency of transfusion, abdominal pain, respiratory difficulty due to gross abdominal distension and sever thrombocytopenia not responding to steroids or IvIg. The data was analysed using paired t test and a P value of < 0.05 was considered significant.

Results: Majority of the patients were in the age group 6 – 10 years (50.625%), followed by 11 – 15 years (31.25%) ,20 patients were male (62.5%) and 12 were female (37.5%). Most common indication for splenectomy was SCD in14 patients (43.75%). The mean duration of surgery was 127.81 (+ 30.07) mins. The mean operative blood loss was 46.56(+30.09) ml, 4 cases were converted to open surgery due to bleeding from splenic hilum. Most common post-operative complications occurred was prolonged ileus in 10 patients (31.25%). In most of the patients oral feeds were started within 24 hours (22 patients (68.75%).The mean duration of analgesia required was 5.28 (+1.83) days. The mean post-operative hospital stay was 6.37(±1.47) days. Follow up blood counts were normal in all patients and no patients had any complication in postoperative period.

Conclusion: Though Laparoscopic Splenectomy is widely accepted to be standard procedure in benign diseases its role in haematological disorders remained controversial. Many surgeons are still reluctant to do LS in patients with enlarged spleen due to high conversion rates to open procedure. With increased expertise and improved technique LS can be safely done. Our study confirms that though there is a steep learning curve involved, with time and growing operator experience it is possible to extend the benefits of the laparoscopic approach to a wider spectrum of these patients including patients having splenomegaly secondary to various haemoglobinopathies.

Keywords: Laparoscopic Splenectomy, Haemoglobinopathies, Haematological disorders, Outcome.