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BACKGROUND: Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION: We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS: A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.
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Embolia , Endocardite Bacteriana , Endocardite , Esplenopatias , Humanos , Esplenopatias/cirurgia , Esplenopatias/complicações , Abscesso/etiologia , Abscesso/cirurgia , Valva Aórtica/cirurgia , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Embolia/complicaçõesRESUMO
Introducción: La esplenectomía es un tratamiento estandarizado en niños con trombocitopenia. El método de laparoscopía, en este tratamiento, minimiza los procesos post-operatorios y se ha difundido su aplicación en la comunidad científica. El objetivo del presente estudio es realizar una descripción de la casuística y utilidad de la esplenectomía laparoscópica en los niños con patología hematológica. Métodos: El presente estudio observacional, retrospectivo se realizó en el Hospital Pediátrico Baca Ortiz. Se revisaron expedientes clínicos de los últimos 10 años de pacientes con indicación de esplenectomía quirúrgica. Se analizan variables demográficas, clínicas y de resultados. Se utiliza estadística descriptiva. Resultados: Ingresaron al estudio 14 pacientes que tuvieron una esplenectomía quirúrgica vía laparoscópica. La mayoría de estos pacientes son del sexo femenino, con patologías hematológicas como esferocitosis y púrpura trombocitopénica idiopática (PTI). En el 50% se realizó colecistectomía además de esplenectomía. El tiempo quirúrgico varió de 60 a 120 minutos. Conclusiones: La esplenectomía laparoscópica es considerada una técnica compleja dentro de los procedimientos de laparoscopia, pero es ideal para los pacientes con patología hematológica, por lo que es la técnica de elección. Una ventaja de la esplenectomía laparoscópica es el menor tiempo de recuperación y hospitalización, con heridas quirúrgicas más pequeñas.
Introduction: Splenectomy is a standardized treatment in children with thrombocytopenia. The laparoscopic method, in this treatment, minimizes post-operative processes and its application has become widespread in the scientific community. The objective of this study is to describe the casuistry and usefulness of laparoscopic splenectomy in children with hematological pathology. Methods: This retrospective, observational study was conducted at Baca Ortiz Pediatric Hospital. Medical records of the last 10 years of patients with an indication for surgical splenectomy were reviewed. Demographic, clinical and outcome variables are analyzed. Descriptive statistics are used. Results: Fourteen patients who had a laparoscopic surgical splenectomy entered the study. Most of these patients are female, with hematological pathologies such as spherocytosis and idiopathic thrombocytopenic purpura (ITP). In 50% a cholecystectomy was performed in addition to splenectomy. The surgical time ranged from 60 to 120 minutes. Conclusions: Laparoscopic splenectomy is considered a complex technique within laparoscopic procedures, but it is ideal for patients with hematological pathology, so it is the technique of choice. An advantage of laparoscopic splenectomy is the shorter recovery time and hospitalization, with smaller surgical wounds
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Humanos , Esplenectomia , Doenças HematológicasRESUMO
INTRODUCTION AND OBJECTIVES: Laparoscopic splenectomy (LS) is a supportive intervention for cirrhotic patients. However, its efficacy for patients with cirrhotic portal hypertension (CPH) still needs clarification. Studies indicated YKL-40 might be effective targets for treatment of splenomegaly, however deeper insights are unclear. The aim of this study was to investigate the effect of LS on the formation of portal vein thrombosis (PVT) and serum levels of a fibrosis marker, YKL-40, in patients with CPH. MATERIALS AND METHODS: A total of 80 patients who underwent LS and 30 healthy controls were investigated in this study. Serum levels of YKL-40 were measured by enzyme-linked immunosorbent assay (ELISA). Demographic characteristics including age and gender were recorded. Clinicopathological and laboratory examinations included the severity of esophageal varices and the presence of viral hepatitis. The liver function was assessed according to the Child-Pugh classification. The incidence of PVT before and after operation was also monitored. RESULTS: Serum YKL-40 was significantly increased in CPH patients, and was associated with Child-Pugh score and HBV infection. Furthermore, elderly patients had an increased risk for postoperative PVT. Higher serum YKL-40 was observed in patients with thrombus at postoperative 7, 14 and 21 days than those without thrombus. CONCLUSIONS: LS could reduce serum YKL-40 levels and PVT progression and was a useful treatment for patients <40 years of age with CPH.
Assuntos
Proteína 1 Semelhante à Quitinase-3/sangue , Hipertensão Portal/sangue , Cirrose Hepática/sangue , Veia Porta , Complicações Pós-Operatórias/sangue , Esplenectomia , Esplenopatias/cirurgia , Trombose/sangue , Adulto , Estudos de Casos e Controles , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hiperesplenismo/etiologia , Hiperesplenismo/cirurgia , Hipertensão Portal/etiologia , Laparoscopia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Esplenopatias/etiologia , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Esplenomegalia/etiologia , Esplenomegalia/cirurgia , Trombose/epidemiologiaRESUMO
Introducción: la esplenectomía laparoscópica apareció con el desarrollo de la cirugía de mínimo acceso, se conviertió en la técnica preferida para la exéresis del bazo actualmente. Objetivo: evaluar los resultados de la esplenectomía videolaparoscópica en el tratamiento de las enfermedades hematológicas funcionales benignas. Método: se realizó un estudio descriptivo, longitudinal y prospectivo en 86 pacientes con diagnóstico de enfermedades hematológicas funcionales benignas, atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras desde octubre de 1996 hasta diciembre de 2011. Resultados: en la serie predominó el sexo femenino con 70,9 por ciento y la edad media fue de 40 años (37,8 por ciento). Las enfermedades más frecuentes fueron la púrpura trombocitopénica inmunológica (68,6 por ciento), la anemia hemolítica autoinmune con 23,3 por ciento y la esferocitosis hereditaria con 5,8 por ciento. Requirieron preparación preoperatoria 59,3 por ciento de los pacientes con 50,9 por ciento de respuesta efectiva a esta. El tiempo quirúrgico promedio fue 129 minutos. Como accidentes transoperatorios prevalecieron: la ruptura de la bolsa extractora con 12,8 pr ciento y el sangrado del hilio esplénico con 5,8 por ciento. Esto motivó la conversión a cirugía convencional y la exclusión del seguimiento de 6 pacientes. La complicación posoperatoria más frecuente fue el vómito persistente. El seguimiento de los pacientes se realizó desde los 7 días hasta los 2 años en 78 por ciento de los casos, con un tiempo promedio de 518 días. Hubo remisión total de su enfermedad en 82,7 por ciento de los pacientes, remisión parcial en 15,4 por ciento y solamente 1,9 por ciento no presentó remisión. Conclusiones: la esplenectomía videolaparoscópica es una técnica segura y efectiva en el tratamiento de las enfermedades hematológicas autoinmunes en cirujanos con experiencia en Cirugía de Mínimo Acceso de Avanzada(AU)
Introduction: Laparoscopic splenectomy appeared with the development of minimal access surgery. At the moment, it has become the technique preferred for the spleen exeresis. Objective: To evaluate the outcomes of videolaparoscopic splenectomy in the treatment of benign functional hematological diseases. Method: A descriptive, longitudinal and prospective study was carried out with 86 patients diagnosed with benign functional hematological diseases, attended at Hermanos Ameijeiras Clinical Surgical Hospital, from October 1996 to December 2011. Results: In the series, the female sex predominated (70.9 percent) and the average age was 40 years (37.8 percent). The most frequent diseases were immunological thrombocytopenic purpura (68.6 %), autoimmune hemolytic anemia (23.3 percent), and hereditary spherocytosis (5.8 percent). 59.3 percent of patients required a preoperative preparation, with 50.9 percent of effective response to it. The average surgical time was 129 minutes. The prevailing transoperative accidents were: the rupture of the extractor bag (12.8 percent) and the bleeding of the splenic hilum (5.8 percent). This motivated the change to conventional surgery and the exclusion of the follow-up of 6 patients. The most frequent postoperative complication was persistent vomiting. The follow-up of the patients was carried out from 7 days to 2 years in 78 percent of the cases, with an average time of 518 days. There was total remission of their disease in 82.7 percent of the patients, partial remission in 15.4 percent, and only 1.9 percent did not present any remission. Conclusions: Videolaparoscopic splenectomy is a safe and effective technique in the treatment of autoimmune hematological diseases for surgeons with experience in advanced minimal access surgery(AU)
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Humanos , Feminino , Adulto , Esplenectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Doenças Hematológicas/diagnóstico , Epidemiologia Descritiva , Estudos Prospectivos , Estudos Longitudinais , Náusea e Vômito Pós-Operatórios/complicaçõesRESUMO
OBJECTIVES: To introduce a new laparoscopic splenectomy (LS) approach. METHODS: Sixteen patients underwent LS with general anaesthesia and carbon dioxide pneumoperitoneum. The details of the surgery are as follows: 1. The omentum was incised along the greater curvature and retracted as much as possible to expose the pancreatic body and tail. 2. The right arteriovenous root in the gastric omentum was ligated to sufficiently expose the pancreatic body and tail. 3. The pancreatic capsula was opened along the inferior margin of the pancreatic tail, elevated and separated until the superior margin of the pancreas was grasped. The entire splenic pedicle was retracted using a string. The branching blood vessels in the splenic hilus were ligated using clamps and separated. The splenogastric and splenophrenic ligaments were transected proximally using an ultrasonic knife, and the thick short gastric blood vessels were clamped. This procedure allows complete exposure of the area above the pancreatic tail where the splenic hilus is located. The splenoportal vasculature was suspended using a 7-0 silk suture to easily manipulate this tissue. The splenic portal vessels were dissected using an ultrasonic knife, and the portal vessels were isolated individually using vascular clamps and transected. The splenogastric and lienorenal ligaments were also transected. The spleen was then placed into a bag, and the surgical port was slightly enlarged. Finally, the spleen was sectioned for removal. RESULTS: Fifteen surgeries were successfully performed from March 2015 to January 2016. One patient underwent laparotomy. No patients developed postoperative intra-abdominal haemorrhage or infection. One patient developed subcutaneous emphysema, and one developed a wound infection. No deaths occurred. CONCLUSIONS: Active exposure of the area dorsal to the pancreatic tail is a safe and simple splenectomy method.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Pâncreas/cirurgia , Esplenectomia/métodos , Laparoscopia/métodos , Esplenectomia/efeitos adversos , Reprodutibilidade dos Testes , Fatores de Risco , Perda Sanguínea Cirúrgica , Resultado do Tratamento , Laparoscopia/efeitos adversos , Duração da CirurgiaRESUMO
Introducción: La esplenectomía laparoscópica se ha convertido en la técnica Gold Standard para la patología benigna del bazo. Debido a la posición anatómica, fragilidad y gran riego sanguíneo del bazo este procedimiento requiere un equipo con formación en cirugía laparoscópica de avanzada. Objetivos: Presentación de la experiencia inicial en esplenectomía laparoscópica realizada en un sistema médico asistencial cerrado por un equipo entrenado en cirugía laparoscópica de avanzada. Lugar de aplicación: Diseño: Retrospectivo, observacional, de corte transversal. Población: 6 esplenectomías laparoscópicas programadas realizadas entre agosto de 2010 y junio de 2012. Material y métodos: Se realizaron 6 esplenectomías laparoscópicas entre agosto de 2010 y junio de 2012. La vía de abordaje fue laparoscópica con 3 trócares. Resultados: En todos los casos se usaron 3 puertos de trabajo, no requiriendo conversión a cirugía abierta. En 2 casos se utilizó morcelación del bazo y en 4 se amplió la incisión umbilical para extraer la pieza. Conclusiones: La esplenectomía laparoscópica es una técnica segura y efectiva, en nuestra casuística ningún paciente requirió convertir la técnica a cirugía abierta y no tuvimos morbilidad. Debe ser realizada por un equipo con experiencia en cirugía laparoscópica de avanzada. (AU)
Background: Laparoscopic splenectomy has becom e the gold standard for benign splenic disease. Due to its anatomical position, fragility and blood supply this procedure requires a trained laparoscopic teamObjective: Presentation of the initial experience in laparoscopic splenectomy performed in a medical care closed system by atrained laparoscopic team. Setting: Division of General Surgery.Policlínico del Docente. Design:Retrospective, observational, cros-sectional study.Population: 6 laparoscopic splenectomy scheduled betweenAugust 2010 and June 2012. Methods:WeÆve performed 6 laparoscopic splenectomy between August 2010 and June 2012. The surgical approach waslaparoscopic with 3 trocars. Results: In all cases we used three working ports, not requiring conversion to traditional open surgery. In 2 cases we used morcellation of the spleen and in 4 umbilical incision wasextended to remove the piece.Conclusions:Laparoscopic splenectomy is a safe and effective,none of our patients required convertion to traditional open surgery and had no morbidity. Must be performed by a trained laparoscopic team. (AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Esplenectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , EsplenopatiasRESUMO
Introducción: La esplenectomía laparoscópica se ha convertido en la técnica Gold Standard para la patología benigna del bazo. Debido a la posición anatómica, fragilidad y gran riego sanguíneo del bazo este procedimiento requiere un equipo con formación en cirugía laparoscópica de avanzada. Objetivos: Presentación de la experiencia inicial en esplenectomía laparoscópica realizada en un sistema médico asistencial cerrado por un equipo entrenado en cirugía laparoscópica de avanzada. Lugar de aplicación: Diseño: Retrospectivo, observacional, de corte transversal. Población: 6 esplenectomías laparoscópicas programadas realizadas entre agosto de 2010 y junio de 2012. Material y métodos: Se realizaron 6 esplenectomías laparoscópicas entre agosto de 2010 y junio de 2012. La vía de abordaje fue laparoscópica con 3 trócares. Resultados: En todos los casos se usaron 3 puertos de trabajo, no requiriendo conversión a cirugía abierta. En 2 casos se utilizó morcelación del bazo y en 4 se amplió la incisión umbilical para extraer la pieza. Conclusiones: La esplenectomía laparoscópica es una técnica segura y efectiva, en nuestra casuística ningún paciente requirió convertir la técnica a cirugía abierta y no tuvimos morbilidad. Debe ser realizada por un equipo con experiencia en cirugía laparoscópica de avanzada.
Background: Laparoscopic splenectomy has becom e the gold standard for benign splenic disease. Due to its anatomical position, fragility and blood supply this procedure requires a trained laparoscopic teamObjective: Presentation of the initial experience in laparoscopic splenectomy performed in a medical care closed system by atrained laparoscopic team. Setting: Division of General Surgery.Policlínico del Docente. Design:Retrospective, observational, cros-sectional study.Population: 6 laparoscopic splenectomy scheduled betweenAugust 2010 and June 2012. Methods:Weve performed 6 laparoscopic splenectomy between August 2010 and June 2012. The surgical approach waslaparoscopic with 3 trocars. Results: In all cases we used three working ports, not requiring conversion to traditional open surgery. In 2 cases we used morcellation of the spleen and in 4 umbilical incision wasextended to remove the piece.Conclusions:Laparoscopic splenectomy is a safe and effective,none of our patients required convertion to traditional open surgery and had no morbidity. Must be performed by a trained laparoscopic team.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Esplenopatias , Esplenectomia , LaparoscopiaRESUMO
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
Introducción: en 1991, Delaitre y colaboradores reportaron la primera esplenectomía laparoscópica exitosa. Ésta se ha convertido en el procedimiento de elección en pacientes con enfermedades hematológicas que requieren tratamiento quirúrgico. Las ventajas potenciales del abordaje laparoscópico sobre el convencional son menor estancia intrahospitalaria, retorno más rápido a la vía oral y disminución en las tasas de morbilidad y mortalidad. Material y métodos: de junio de 1993 a diciembre de 2004, 42 pacientes fueron sometidos a esplenectomía laparoscópica tanto en el Texas Endosurgery Institute como en el Hospital San José del Tecnológico de Monterrey. Las variables utilizadas para valorar eficacia y seguridad fueron tiempo quirúrgico, estancia intrahospitalaria, inicio de la vía oral, conversión a procedimiento abierto, morbilidad y mortalidad. Resultados: las enfermedades hematológicas representaron el diagnóstico más común. El procedimiento fue técnicamente exitoso en 95 % de los casos. Solamente hubo dos conversiones a cirugía convencional. El tiempo quirúrgico promedio fue de 120 minutos. La tasa de mortalidad fue de 2.3 % y la estancia intrahospitalaria y el inicio de la vía oral promedios, de cuatro y dos días, respectivamente. Conclusiones: nuestra serie contribuye a reafirmar que actualmente la esplenectomía laparoscópica representa un método seguro y efectivo, conservando además algunas de las ventajas de los procedimientos mínimamente invasivos.
BACKGROUND: In 1991, Delaitre et al. reported the first successful laparoscopic splenectomy. This procedure has become the best option in patients with hematological diseases and who require surgical treatment. The potential advantages of the laparoscopic approach over the conventional surgery are shorter length of hospital stay, shorter time to resume normal diet and decreased rates of morbidity and mortality. METHODS: From June 1993 to December 2004, 42 patients underwent laparoscopic splenectomy in our two surgical care centers: Texas Endosurgery Institute and Hospital San José-TEC de Monterrey. The measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Hematological diseases were the most common diagnosis. The procedure was technically successful in 95% of the patients. There were two conversions to open surgery. The mean operating time was 120 min. Mortality rate was 2.3%. The mean length of hospital stay and time to resume normal diet were 4 and 2 days, respectively. CONCLUSIONS: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method, retaining some advantages of minimally invasive techniques.