Die laparoskopische Splenektomie mit dem „Essener Manöver” zur Behandlung benigner und maligner hämatologischer Erkrankungen

Zusammenfassung

Die laparoskopische Splenektomie hat trotz ihrer frühen Erstbeschreibung noch nicht den Rang einer Standardoperation erreicht, zumal weder die Indikationsstellung noch die operative Vorgehensweise standardisiert sind. Dies gilt insbesondere für die Frage der laparoskopischen Splenektomie bei maligner Grundkrankheit. Wir führen seit 1994 die laparoskopische Splenektomie in einer 4-Trokartechnik mit Dissektion des Milzhilus durch das so genannte „Essener Manöver” durch und berichten erstmals über diese Technik und deren Ergebnisse bei 68 Patienten mit benigner (n = 42) und maligner (n = 26) hämatologischer Erkrankung. Nebenmilzen wurden in 17 % der Patienten gefunden und exstirpiert. Die Konversionsrate zur Laparotomie betrug 9 % (8 von 68 Pat.), die 30-Tage-Letalität 1,4 % (1 Pat.). Insgesamt 11-mal kam es zu relevanten Blutungen, die bei 3 Patienten zur Konversion zur Laparotomie und in einem Fall zur Relaparotomie führten. Die laparoskopische Splenektomie ist eine neue minimal-invasive Therapieoption bei benigner und maligner hämatologischer Erkrankung, deren wesentliches Risiko in intraoperativen Blutungen besteht.

Abstract

Despite its early description, laparoscopic splenectomy has not yet reached the level of a standard operation as a therapeutic option for haematological disease, especially for malignant disorders. We performed laparoscopic splenectomies in a modified 4 port technique and dissection of the splenic vessels by the „Essen-Manoeuvre” and report on 68 attempted laparoscopic splenectomies for benign (n = 42) and malignant (n = 26) haematological disorders. Conversion rate was 9 %, 30-days-mortality was 1.4 %, perioperative morbidity was 11 %, respectively. Accessory spleens were found and resected in 17 % of our patients. Laparoscopic splenectomy is a new minimally invasive option for patients with benign and malignant haematological disease fraught with a special risk of intraoperative bleeding.

Schlüsselwörter

Laparoskopie - Splenektomie - Hämatologische Erkrankungen - Essener Manöver

Key words

Laparoscopy - Splenectomy - Haematological disorders - Essen-Manoeuvre

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