BACKGROUND: Since 1994, 27 @entity1 at our institution have undergone laparoscopic splenectomy for @entity3039 ( @entity3039 ). Laparoscopic splenectomy was completed in 22 of these @entity1 . We sought to identify factors that precluded successful laparoscopic splenectomy in the remaining 5 @entity1 . METHODS: Retrospective review of 27 @entity1 with @entity3039 undergoing laparoscopic splenectomy was performed at Duke University Medical Center from August, 1994 to September, 1997. RESULTS: Laparoscopic splenectomy was performed in 16 @entity1 and 11 @entity1 with a mean age of 47.2 years. Five (18%) of these procedures were converted to open splenectomy. There was no significant difference in age, ASA score, gender, weight, height, or splenic size between the converted and laparoscopic groups. However, preoperative and postoperative platelet counts were significantly higher in the laparoscopic group than in the converted group (p < 0.001). Operative times also were significantly longer for the laparoscopic group than for the converted group (p < 0.001). Adherent adjacent structures, associated comorbidities, and technical errors prohibited laparoscopic completion in five @entity1 . @entity2246 with @entity548 required conversion in two @entity1 . A thickened greater omentum blanketing the splenic capsule and a densely adherent pancreatic tail extending well into the splenic hilum prevented laparoscopic completion in two @entity1 . Increased peak airway pressures greater than 60 mmHg after pneumoperitoneum necessitated conversion in the remaining @entity1 , who had a previous history of @entity338 . Regardless of surgical approach, all @entity1 achieved a therapeutic response after splenectomy. Splenectomies completed laparoscopically resulted in a significantly shorter length of hospital stay (p < 0.01). CONCLUSIONS: Densely adherent adjacent structures, technical errors, and cardiopulmonary instability may preclude successful completion of laparoscopic splenectomies. Thorough preoperative evaluation with an emphasis on the cardiopulmonary system may elicit a cohort of individuals with @entity3039 who are unlikely to undergo laparoscopic splenectomy successfully. This cohort also may include individuals with preoperative platelet counts less than 35,000 mm(-3).

Conversion factors for laparoscopic splenectomy for XXXX .

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient', 'men'] @entity548 :: ('MESH:D006470', 'Disease') :: ['subsequent bleeding'] @entity338 :: ('MESH:D011665', 'Disease') :: ['pulmonary insufficiency'] @entity3039 :: ('MESH:D016553', 'Disease') :: ['immune thrombocytopenic purpura', 'ITP'] @entity2246 :: ('MESH:D008661', 'Disease') :: ['Technical errors']
@entity3039 :: (MESH:D016553,Disease) :: ['immune thrombocytopenic purpura']
