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91110

Laparoscopic Staple-less Splenectomy: feasibility and benefits

Article

Last updated: 22 Jan 2023

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Abstract

Background: The surgical procedures of the spleen include open splenectomy (OS) laparoscopic splenectomy (LS). Several techniques for control of splenic vessels during LS have been developed, such as Clips, sutures, bipolar vessel sealing devices as Liga-Sure and ultrasonic devices as Harmonic have. The vessel sealing devices shows some advantages if compared with other methods such as staplers and clips as shorter hospital stay, safer, feasible and excellent cosmetic results. And vessel sealing devices (Liga-Sure) LS is cheap alternative to the use of endo-staplers which is expensive. Objectives: The study is to evaluate feasibility, merits and demerits of staple-less laparoscopic splenectomy in cases of non-traumatic disorders of spleen and assess operative time, need for blood transfusion, rate of conversion to open splenectomy or use stapler, period of hospital stay and associated complications. Patients and Methods: The study was conducted on 32 patients, underwent laparoscopic splenectomy using vessel sealing devices (Ligasure) for splenic pedicle control. Informed consent was obtained for all patients. Results: The study was conducted on 32 patients. 30 patients (93.80%) were females and 2 patients (6.3%) were males. 30 patient with immune thrombocytopenic purpura (ITP) and 2 patients with hereditary spherocytosis (HS). Two cases (6.3%) detected with accessory spleen (splenule) at the splenic hilum. Two cases (6.3%) were converted to open splenectomy. To control bleeding, we used stapler in two cases (6.3%). Cost of staple-less LS is less expensive than stapler laparoscopic splenectomy as the stapler LS is more than staple-less LS  by about 12000 EGP (700$). Conclusion: In a report in early 1990s, the dissection of the hilum of the spleen was generally achieved by surgical clips or endo-gastrointestinal staplers. Subsequently, new surgical tools such as ultrasonic devices or bipolar electrosurgical devices such as LigaSure had been employed as supporting device that can seal blood vessels with supra-physiologic burst pressures equal to those obtained with surgical clips or ligatures. We, in this series, believe that it is, with a statistical significance, safe and effective, reduces blood loss, minimize operating time, fewer costs and is a valid. Moreover, it reduced conversion rates in selected patients. Last but not least, the use of the vessel sealing devices (Ligasure) resulted in no post-operative complications or need of blood transfusion.

DOI

10.21608/ejmr.2020.91110

Keywords

Staple-less, Laparoscopic Splenectomy, Ligasure, Vessel sealing device

Authors

First Name

Hesham

Last Name

Nafady

MiddleName

Ahmed

Affiliation

General Surgery Department, Faculty of Medicine, Beni-Suef University, Egypt

Email

heshamahmednafady@yahoo.com

City

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Orcid

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First Name

Ahmed

Last Name

Rashad

MiddleName

Mohamed

Affiliation

General Surgery Department, Faculty of Medicine, Beni-Suef University, Egypt

Email

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City

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Orcid

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First Name

Mohammed

Last Name

Sayed

MiddleName

-

Affiliation

General Surgery Department, Faculty of Medicine, Beni-Suef University

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City

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Orcid

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Volume

1

Article Issue

2

Related Issue

13399

Issue Date

2020-06-01

Receive Date

2020-05-21

Publish Date

2020-06-01

Page Start

83

Page End

94

Print ISSN

2682-4396

Online ISSN

2682-440X

Link

https://ejmr.journals.ekb.eg/article_91110.html

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https://ejmr.journals.ekb.eg/service?article_code=91110

Order

8

Type

Original Article

Type Code

1,224

Publication Type

Journal

Publication Title

Egyptian Journal of Medical Research

Publication Link

https://ejmr.journals.ekb.eg/

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Article

Created At

22 Jan 2023