Consecutive laparoscopic gallbladder and spleen resections in cirrhotic patients

Table 1 Demographic characteristics and preoperative information

Variable	Group 1	Group 21	Group 32
Cases	17	58	14
Sex (M/F)	10/7	26/32	8/6
Age (yr)	55.9 ± 12.9	49.7 ± 14.5	50.8 ± 7.6
ASA classification
II	1	13	0
III	15	42	13
IV	1	3	1
Child-Pugh class
A	7	37	10
B	10	19	4
C	0	2	0
Splenic size (cm)	24.8 ± 6.8	22.1 ± 4.9	24.6 ± 3.3
Laboratory data
HGB (g/L)	96.0	111.5	116.0
	(86.0-128.0)	(91.5-125.0)	(93.0-133.5)
Platelet (× 109/L)	34.0	37.0	37.5
	(27.0-38.5)	(27.0-44.5)	(32.0-51.0)
WBC (× 109/L)	2.0	2.2	2.6
	(1.7-3.2)	(1.7-3.0)	(1.7-3.5)
Total bilirubin (mmol/L)	24.2	21.0	16.3
	(14.3-39.6)	(16.0-25.3)	(15.5-19.1)
AST (IU/L)	50.0	31.5	38.5
	(24.5-83.0)	(22.0-45.8)	(30.3-47.0)
ALT (IU/L)	34.0	33.5	33.0
	(25.0-74.0)	(25.8-50.3)	(25.0-42.5)
ALB (g/L)	37.5	38.3	39.6
	(34.2-39.5)	(34.8-40.8)	(36.6-42.2)
Prothrombin time (s)	13.2	12.9	13.8
	(12.5-15.1)	(11.2-14.9)	(12.3-14.7)
Diagnoses
Posthepatitic cirrhosis	17	51	11
Alcoholic cirrhosis	0	4	1
Schistosomiasis cirrhosis	0	3	2

Data are expressed as absolute median (range) or mean ± SD. No significant differences were detected for

¹group 1 vs group 2 or

²group 1 vs group 3. ASA: American Society of Anaesthesiologists; HGB: Haemoglobin; WBC: White blood cell; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALB: Albumin.

Table 2 Intraoperative information

Variable	Group 1	Group 2	Group 3	P1
Conversion rate	1 (5.9)	3 (5.2)	ND	ND
Operative time (min)	221.2 ± 44.8	218.0 ± 58.4	166.4 ± 64.5	0.009
Transfusion rate	3 (17.6%)	8 (13.8%)	5 (35.7%)	NS
EBL (mL)	225.9 ± 195.7	170.2 ± 130.2	421.4 ± 234.3	0.017
Additional operation
Liver biopsy	17	58	14	ND

Data are expressed as n (%) or mean ± SD. ¹Group 1 vs group 3. EBL: Estimated blood loss; NS: No significance; ND: Analysis not done.

Table 3 Postoperative information

Variable	Group 1	Group 2	Group 3	P1
Postoperative stay (d, mean ± SD)	8.7 ± 2.6	7.8 ± 1.8	11.3 ± 2.9	0.013
Oral intake (d, mean ± SD)	2.8 ± 1.4	2.2 ± 0.9	4.3 ± 1.1	0.004
Histologic fibrosis stage				NS
F3	5	11	4	ND
F4	12	45	9	ND
Short-term complications
CBD injury	0	ND	0	ND
Bile leakage	0	ND	0	ND
Splenic fossa collection	1	1	0	ND
Pleural effusion	1	4	2	ND
Pulmonary infection	1	3	3	ND
Incision infection	0	0	2	ND
Pancreatic leakage	2	8	1	ND
Portal or splenic vein thrombosis	2	4	1	ND
Postoperative bleeding	1	2	0	ND
Total	8	22	9	ND

¹Group 1 vs group 3. CBD: Common bile duct; NS: No significance; ND: analysis not done.

Table 4 Dynamic changes of haematological and liver function parameters perioperatively

Parameter	Preoperative	POD 1	POD 3	POD 5
HGB (g/L)
Group 1	96.0 (86.0-128.0)	102.0 (86.0-119.5)	108.0 (89.5-118)	105.0 (88.5-115.5)
Group 2	111.5 (91.5-125.0)	107.0 (92.8-119.0)	102.0 (90.8-118.0)	105.5 (93.8-120.3)
Group 3	116.0 (93.0-133.5)	101.0 (91.3-126.3)	105.5 (88.3-127.3)	111.5 (89.8-123.5)
Platelet (× 109/L)
Group 1	34.0 (27.0-38.5)	63.0 (39.5-81.0)a	105.0 (50.0-175.5)a	184.0 (127.5-303.0)a
Group 2	37.0 (27.0-44.5)	63.0 (42.0-79.0)a	115.0 (74.3-160.5)a	192.0 (130.8-307.3)a
Group 3	37.5 (32.0-51.0)	54.0 (41.8-78.8)a	118.0 (59.8-138.5)a	242.5 (110.0-285.3)a
WBC (× 109/L)
Group 1	2.0 (1.7-3.2)	11.1 (8.1-14.9)a	10.5 (8.1-12.5)a	9.1 (7.3-10.6)a
Group 2	2.2 (1.7-2.9)	11.1 (8.9-13.3)a	10.4 (8.4-13.8)a	8.6 (6.7-10.4)a
Group 3	2.6 (1.7-3.5)	13.3 (10.2-14.9)a	12.1 (8.9-15.3)a	9.2 (7.6-11.1)a
TBil (mmol/L)
Group 1	24.2 (14.3-39.6)	27.8 (14.5-34.6)	21.3 (17.3-35.5)	24.0 (17.3-30.3)
Group 2	21.0 (16.0-25.3)	21.8 (14.5-31.0)	20.1 (13.5-26.7)	19.5 (12.8-28.0)
Group 3	16.3 (15.5-19.1)	15.1 (12.0-20.0)	24.3 (15.0-31.7)	19.4 (13.5-26.7)
ALT (IU/L)
Group 1	34.0 (25.0-74.0)	43.0 (28.5-99.0)	40.0 (31.5-57.5)	42.0 (26.0-58.0)
Group 2	33.5 (25.8-50.3)	32.5 (27.8-53.3)	33.5 (24.8-54.0)	31.5 (21.8-43.0)
Group 3	33.0 (25.0-42.5)	37.5 (26.8-75.8)	34.0 (27.5-57.0)	32.0 (20.2-54.5)
AST (IU/L)
Group 1	50.0 (24.5-83.0)	52.0 (42.5-91.0)	43.0 (26.5-54.0)	34.0 (28.0-58.5)
Group 2	31.5 (22.0-45.8)	44.5 (34.8-64.0)	38.5 (28.0-53.0)	33.5 (26.0-49.0)
Group 3	38.5 (30.3-47.0)	47.0 (41.8-83.0)	40.5 (33.5-71.5)	38.5 (24.5-55.0)
ALB (g/L)
Group 1	37.5 (34.2-39.5)	29.0 (26.8-32.5)a	31.6 (28.9-32.9)a	32.4 (30.5-35.5)a
Group 2	38.3 (34.8-40.8)	31.5 (28.0-34.7)a	32.3 (29.5-35.1)a	34.2 (31.9-38.0)a
Group 3	39.6 (36.6-42.2)	27.8 (25.9-33.2)a	35.3 (31.9-36.5)a	34.5 (30.0-38.1)a

^aP < 0.05 vs preoperative status within the group. HGB: Haemoglobin; WBC: White blood cell; TBil: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; POD: Postoperative days.

Table 5 Reports in the literature of laparoscopic cholecystectomy plus laparoscopic splenectomy

Ref.	Year	n	Main diagnosis	Surgical sequence	Conversion rate	Morbidity
Trías et al[26]	1994	1	Hereditary spherocytosis	LC → LS	NR	NR
Patton et al[15]	1997	1	Hereditary spherocytosis	LC → LS	NR	Atelectasis
Caprotti et al[31]	1999	7	Hereditary spherocytosis	LC → LS	NR	NR
Brink et al[32]	2003	1	Autoimmune haemolytic anaemia	LC → LS	NR	PSVT
Rossi et al[34]	2007	1	Congenital haemolytic anaemia	NR	NR	PSVT
Choi et al[33]	2007	2	Hereditary spherocytosis	LC → LS	NR	NR
Sasaki et al[14]	2010	9	Hereditary spherocytosis (n = 4)	LS → LC	NR	PSVT
			Splenic artery aneurysm (n = 2)
			Hypersplenism with liver cirrhosis (n = 2)
			Evans syndrome (n = 1)
Nobili et al[16]	2011	30	Hereditary spherocytosis (n = 22)	LC → LS	1 (3.3%)	Hemoperitoneum
			Thalassemia (n = 4)
			Idiopathic thrombocytopenic purpura (n = 3)
			Sickle cell disease (n = 1)

PSVT: Portal or splenic vein thrombosis; NR: Not reported: LC: Laparoscopic cholecystectomy; LS: Laparoscopic splenectomy.