RESUMO
BACKGROUND: Since 1979, we have been studying subtotal splenectomy. This procedure was used in over 200 patients to treat splenic trauma, portal hypertension, myeloid metaplasia due to myelofibrosis, Gaucher disease, chronic lymphocytic leukemia, retarded growth, and sexual development associated with splenomegaly, and disorders of the pancreatic tail. On the basis of our clinic experience with laparoscopic splenectomy with and without splenic autotransplantation, open subtotal splenectomy, and after a training period with laparoscopic conservative splenic operations on animals, this communication presents laparoscopic subtotal splenectomy as a new treatment of severe pain due to ischemia of the spleen. PATIENTS AND METHODS: Two patients with severe splenic pain due to ischemia provoked by vascular obstruction of the spleen were successfully treated by laparoscopic subtotal splenectomy, with preservation of the upper splenic pole supplied only by the gastrosplenic vessels. RESULTS: This procedure was safely conducted with minor bleeding and no technical difficulties or complications. The postoperative follow-up of 5 and 21 months has been uneventful and the pain disappeared since the first postoperative day. CONCLUSIONS: It is feasible and safe to perform subtotal splenectomy by laparoscopy. This procedure seems to be a good treatment for pain due to splenic ischemia.
Assuntos
Laparoscopia/métodos , Baço/cirurgia , Esplenectomia/métodos , Esplenopatias/cirurgia , Adulto , Estudos de Viabilidade , Humanos , Isquemia/complicações , Masculino , Dor/cirurgia , Fatores de RiscoRESUMO
RACIONAL: Desde 1979 este grupo de autores executa esplenectomia conservadora através de esplenectomia sub-total e autotransplante esplênico. Estes procedimentos foram realizados em mais de 300 pacientes para tratar diferentes condições patológicas. OBJETIVO: Apresentar proposta original e inédita em seres humanos de esplenectomia subtotal, preservando apenas o pólo superior do baço por via laparoscópica e esplenectomia total complementada por implante autógeno de tecido esplênico, também pela via laparoscópica, como nova forma de tratamento da dor severa devida à isquemia do baço. MÉTODOS: Três pacientes com intensa dor no hipocôndrio esquerdo foram submetidos a grande número de exames para concluir que sua dor era provocada por isquemia de parte do baço. A dor era resistente a todos os métodos conservadores utilizados. Decidiu-se, então, pelo tratamento cirúrgico por meio da esplenectomia subtotal, preservando o pólo superior do baço suprido pelos vasos esplenogástricos em dois casos, e esplenectomia total complementada por implante no omento maior de 20 fragmentos retirados desse baço, no terceiro caso. As três operações foram realizadas por via laparoscópica. Os três doentes foram acompanhados com exames hematológicos, imunológicos, tomográficos e cintilográficos. RESULTADOS: Esses procedimentos foram conduzidos sem risco para os paciente e com sangramento mínimo. Não houve dificuldade técnica nem complicações per ou pós-operatórias. No seguimento, não foram constatadas anormalidades, comprovando-se a vitalidade e a função dos remanescentes esplênicos. A dor esplênica desapareceu desde o dia da operação e não retornou durante o período de acompanhamento. CONCLUSÃO: A esplenectomia subtotal e os auto-implantes esplênicos são factíveis por via laparoscópica, de maneira segura para os doentes e devem deve ser considerados no tratamento da dor de origem isquêmica do baço.
BACKGROUND: Since 1979 this group of authors is doing conservative splenic surgical procedures by mean of subtotal splenectomy and splenic autotransplantation. These procedures were used in over 300 patients to treat different pathological conditions. AIM: To present for the first time in the world subtotal splenectomy and splenic autotransplantation by laparoscopic means, as a new treatment for severe pain due to ischemic spleen. METHODS: Three patients presented left abdominal severe pain due to diffuse ischemia of the spleen. This symptom was resistant to all conservative treatment. Laparoscopic subtotal splenectomy, with preservation of the upper splenic pole was indicated in two cases because this was the only part of the spleen without signs of ischemia. In a third patient ischemia was diffuse and total splenectomy with 20 implants of the splenic tissue on the greater was carried out. RESULTS: These procedures were safely conducted with minor bleeding and no technical difficulties or complications. The postoperative follow-up has been uneventful and hematological, immunological, tomographic and scintigraphic exams confirmed the vitality and functionality of the splenic remnants. The pain disappeared since the first post-operative day in the three patients. CONCLUSION: It is feasible and safe to perform subtotal splenectomy and splenic autotransplants by laparoscopy and these procedures seem to be a good treatment for pain due to ischemic spleen.
RESUMO
Since 1990, we have performed splenic autotransplantation in more than 100 patients to treat splenic trauma, portal hypertension, myeloid metaplasia due to myelofibrosis, chronic lymphocytic leukemia, and Gaucher disease. The aim of this present study was to present splenic autotransplantation performed by laparoscopic means. A 33-year-old woman with severe splenic pain due to ischemia caused by multiple focal thromboses of splenic arterial branches was successfully treated by laparoscopic splenectomy and splenic tissue autotransplantation. The spleen was removed and cut in 20 fragments that were sutured to the greater omentum. This procedure was safely conducted with minor bleeding and no technical difficulties or complications. The postoperative follow-up of 12 months has been uneventful; the patient's pain disappeared on the first postoperative day. Hematologic, immunologic, tomographic, and scintigraphic examinations confirmed the functions of the splenic autotransplants. It is feasible and safe to perform splenic autotransplants by laparoscopic means.
Assuntos
Laparoscopia , Baço/transplante , Adulto , Feminino , Humanos , Transplante Autólogo/métodosRESUMO
A introdução da cirurgia por videolaparoscopia trouxe vários benefícios para o paciente e para a instituição como: a redução da permanência hospitalar, do tempo e exposição tecidual, do tamanho da incisão, etc. Este estudo objetivou analisar a incidência da Infecção do sitio cirúrgico (ISC), entre pacientes submetidos a cirurgias de colecistectomias por videolaparoscopia (CVL) e por técnica convencional (CC). Foi realizado um estudo prospectivo, no qual foram acompanhados 98 pacientes, submetidos a CC e CVL, com notificação de 19 ISC. A incidência de ISC para pacientes que se submeteram a cirurgia por CC foi de 32,1% e para CVL 14,3% (OR = 2,25 [1,02-4,94] e p = 0,12). Os resultados obtidos neste estudo mostraram que pacientes que se submeteram à CC apresentaram 2,25 vezes mais chances para a ocorrência da ISC, quando comparados àqueles que fizeram a CVL
The introduction of surgery by video-laparoscopy brought several benefits for patients and for the institution: the reduction of the stay in the hospital, time and incision exposure, size of the incision, etc. This study analyzed the incidence of surgical site infection (SSI) among patients submitted to surgeries of cholecistectomy by videolaparoscopy (CSV) and by conventional technique (CT). It is a prospective study, where 98 patients submitted to CT and CSV were accompanied, with notification of 19 SSI. The incidence of SSI for patients that submitted to CT was 32,1% and for CSV 14,3% (OR = 2,25 [1,02-4,94] and p = 0,12). The results obtained in this study showed that patients submitted to CC had 2,25 times more probability of SSI, when compared to the CSV patients
La introducción de la cirugía por vídeo laparoscopia evidenció varios beneficios para el paciente y para la institución: reducción de la permanencia hospitalaria, del tiempo y exhibición del tejido, del tamaño de la incisión, etc. El objetivo de este estudio fue analizar la incidencia de la infección del sitio quirúrgico (ISQ) entre pacientes sometidos a cirugías de colecistectomia por vídeo laparoscopia (CV) y por la técnica convencional (CC). Se trata de un estudio prospectivo donde se efectuó el seguimiento de 98 pacientes sometidos a CC y CV con notificación de 19 ISQ. La incidencia de ISQ para pacientes sometidos a la cirugía CC fue de 32,1% y para CV de 14,3% (OR = 2,25 [1,02-4,94] y p = 0,12). Los resultados obtenidos en este estudio muestran que pacientes sometidos a CC presentaron 2,25 veces más oportunidades de ocurrencia de ISQ que los sometidos a CV