Laparoscopic Treatment of Hereditary Spherocytosis (Splenectomy Plus Cholecystectomy)
Abstract
Brief Clinical Report Laparoscopic Treatment of Hereditary Spherocytosis (Splenectomy Plus Cholecystectomy) MANUEL TRÃAS, M.D. and EDUARDO MARÃA TARGARONA, M.D. INTRODUCTION laparoscopic cholecystectomy have prompted the application of procedures.1 Laparoscopic splenectomy also has been performed, but this operation poses some specific difficulties for the handling and mobilization of a parenchymatous organ and the retrieval of the specimen.2-6 We present the technique used to perform simultaneously a cholecystectomy and a splenectomy in a patient with hereditary spherocytosis. success and rapid spread The laparoscopic techniques of in major abdominal CASE REPORT A 55-year-old man was diagnosed as having hereditary spherocytosis in 1982, after a study of hemolytic anemia in his daughter. The patient remained asymptomatic, but ultrasonography revealed gallstones. The patient refused surgical treatment and was treated with folinic acid (5 mg/day). In October 1992, the patient suffered several crises of colic pain in the right hypochondrium. Ultrasonography revealed multiple gallstones, thickened gallbladder wall, and splenomegaly. Biochemical studies demonstrated anemia (hematocrit 31%, hemoglobin 10.4 g/dL) and hyperbilirubinemia (total bilirubin 3.9 mg/dL), and surgical treatment was indicated. After the induction of a pneumoperitoneum, a 10-mm umbilical port was introduced, and the abdomen was explored by laparoscopy. Two 5-mm trocars (subxiphoid and right