Nissen fundoplication

Hernia Repair

Colectomy

Cardiomyotomy
(Heller Myotomy)

Splenectomy

Cholecystectomy

Adrenalectomy

Gastric Bypass

Glossary

Members of
SAGES

The Society
of American
Gastrointestinal
Endoscopic
Surgeons

Laparoscopic Splenectomy

The laparoscopic splenectomy is suitable for many patients. After the patient has been anesthetisized, a laparoscope (a tube that contains fiber optics with a lens at one end and a television camera at the other) is inserted into one of three or four half-inch incisions in the abdomen.

The abdominal area is filled with carbon dioxide to open the area for easier access to the spleen. Using tiny surgical instruments inserted through thin trocar tubes the ligaments holding the spleen in place are separated and then the main blood vessels are sealed. The spleen can then be detached and placed in a bag, where it is broken into small pieces that allow the bag to be removed through one of the small incisions. The surgeon looks at a nearby flat-panel display to accurately position and operate the instruments during the procedure. Once the procedure is complete, the instruments and laparoscope are removed and incisions will need only a few stitches each or a special surgical tape to close them. Incision scars will be barely visible once they’ve healed.

One or two days of hospitalization will probably be required for a laparoscopic splenectomy, as opposed to about a week for open surgery. Complete healing should occur within 4 to 6 weeks. In some cases, particularly for patients whose spleens are excessively large (over 1000 gm), the doctor may elect for open surgery instead of the laparoscopic procedure.

Immune Thrombocytopenic Purpura (ITP)

ITP is classified as an autoimmune disease. In an autoimmune disease the body mounts an attack toward one or more seemingly normal organ systems. In ITP, platelets are the target. They are marked as foreign by the immune system and eliminated in the spleen and sometimes, the liver. The ultimate consequence of ITP is spontaneous bleeding resulting from a reduced platelet count (thrombocytopenia). Symptoms can range from easy and frequent bruising to prolonged bleeding after injury. Rarely, intracranial hemorrhage can occur.

Patients who do not respond to conventional medical management may be referred for a splenectomy, or removal of the spleen. The spleen plays a part in maintaining a healthy immune system and cleans the blood of foreign matter. In the case of ITP, removal of the spleen potentially eliminates the source of the abnormal antibodies and may aid the body in maintaining a more normal population of circulating platelets.

Splenectomy has been used to treat ITP since 1913. The most recent data indicates that 60-70% of patients undergoing splenectomy will achieve long lasting remission of ITP, though results vary. The laparoscopic approach is a more recent advance and provides significant recovery benefit over conventional open splenectomy. Doctors Tarnoff and Shikora have unique expertise with laparoscopic splenectomy and may be able to offer you a better, safer surgery.