Purpose: Hereditart spherocytosis is the most common red blood cell membrane disorder, causing hemolytic crisis. Symptoms include anemia, splenomegaly, and often gallstone formation. Splenectomy is the only effective therapy to reduce the
severity of the anemia and the need for blood transfusion. If choleithiasis also is present, cholecystectomy must be performed in addition to splenectomy. Since the introduction of laparoscopic cholecystectomy, various types of intra-abdominal
disease
had been treated by laparoscopic procedures due to its minimal invasiveness. We present out experiences with simultaneous laparoscopic splencetomy and cholecystectomy for the management of hereditary spherocytosis with gallstone and we evaluate
the
advantage, usefulness and safety of this mehtod.
Method: Twenty patients who had undergone concomitant laparoscpic splenectomy and laparoscopic cholecystectomy for hereditary spherocytosis with gallstones between March, 1996 and February, 2002 were evaluated. We conducted a review,
recording
previous abdominal surgery, diagnostic work up, type and method of surgery, morbidity, mortality, postoperative clinical results and hematologic status. Under the CO2 pneumoperitoneum, we performed cholecystectomy first because of the very low
conversion rate. Laparoscoic splenectomy was done in right lateral position. A retrograde analysis was conducted using the medical records of the patients.
Results: The average splenic diameter was 15.7㎝(range, 10~21), and the average weight was 479 gm(range, 310~1010). There were to types of operation performed. Concomitant laparoscopic splenectomy and cholecystectomy were accomplished in
18
cases
and hand-assisted laparoscopic surgery in 2 cases. All operation were completed without any conversion to open surgery. The average operation time was 231 minutes(range, 162~275) and mean estimated blood loss was 132㎖ (range, 85~167). The length
of
stay was 5.7 days(range, 4~7). Only one minor complication(atelectasis) was developed, which were resolved by conservative management. No deaths occurred. After 1 and 6 month follow-up, all patients showed improvement of their hematologic status,
with
hemoglobin 13.1gm/dl, total bilirubin 0.7㎎/dl and reticulocyte 1.6%.
Conclusions: Simultaneous laparoscopic splenectomy and cholecystectomy are safe, feasible and effective procedures for the management of the spherocytosis with gallstones. Hand-assisted laparoscopic surgery is an alternative approach for
overcoming the technical challenges such as splenomegaly.
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