Original Research Article
Year: 2016 | Month: January | Volume: 3 | Issue: 1 | Pages: 31-36
A Retrospective Observational Study on Laparoscopic Splenectomy for Haematological Conditions with Better Peri-Operative Outcomes
S. Sivakumar, Vijay Augustin Jayabal
Consultant Anesthesiologist, Department of Anesthesia, Aysha Hospital ,91, Millers Road, Kilpauk, Chennai-10.
Corresponding Author: S. Sivakumar
1.1 Background: Splenectomy is the surgical removal of the spleen, traditionally accomplished by one large commonly left subcostal or a left upper paramedian incision. The use of smaller incisions with laparoscopic techniques leads to less pain after surgery, less time spent in the hospital and quicker return to the work. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral fluid intake, postoperative pain and complication, were analysed and overall outcome of the laparoscopic splenectomy were observed for a series of haematological cases for whom splenectomy is indicated.
1.2 Methods: Retrospective review of 25 patients who had undergone elective splenectomies between April 2012 and May 2015 were included. Preoperative evaluation was done by haematologist. General anesthesia was given for all patients. Most laparoscopic splenectomise were performed in right lateral position. Local infiltration with 0.5% bupivacaine was given at trocar and port site at the end of the surgery. Intravenous Fentanyl and tramadol were used for post operative pain relief.
1.3 RESULTS : The mean operating time was 74 minutes (range 45min to 90min) in LS alone cases;. The overall mean estimated blood loss was 159.3 ml (range: 50ml to 500ml. The mean hospital stay was 4.83 days (range: 3to12 days). All patients were ambulatory and started oral feeding on first post-operative day. Deep vein thrombosis and pulmonary complication were nil. Mortality was nil in this series. Pain intensity and analgesic (opioids) consumption were less during post-operative period.
1.4 Conclusion :In conclusion LS is a technically difficult but feasible procedure that could be performed safely in carefully selected patients, with adequate optimization and skilled surgical and anesthesiologist team even in a small setting with limited resources, with efficacy morbidity and mortality rates similar to those of traditional splenectomy for the same indications.
Keywords: laparoscopic splenectomy, idiopathic thrombocytopenic purpura, opioids, verbal pain scores (VPS), platelet count.