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J. Clin. Med. 2018, 7(12), 547; https://doi.org/10.3390/jcm7120547

Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases

1
2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Kraków, Poland
2
Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland
*
Author to whom correspondence should be addressed.
Received: 21 November 2018 / Revised: 9 December 2018 / Accepted: 12 December 2018 / Published: 14 December 2018
(This article belongs to the Section Gastroenterology & Hepato-Pancreato-Biliary Medicine)
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PDF [244 KB, uploaded 14 December 2018]

Abstract

Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications. View Full-Text
Keywords: laparoscopic splenectomy; intraoperative difficulties; hemorrhage; perioperative complications; surgical education laparoscopic splenectomy; intraoperative difficulties; hemorrhage; perioperative complications; surgical education
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Wysocki, M.; Radkowiak, D.; Zychowicz, A.; Rubinkiewicz, M.; Kulawik, J.; Major, P.; Pędziwiatr, M.; Budzyński, A. Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases. J. Clin. Med. 2018, 7, 547.

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