Mặc dù sự cần thiết cho truyền intraoperative tăng so với kỹ thuật mở, đặc biệt chú ý trong thời gian thắt các mạch lớn lách và đạt được sự quen thuộc với đặc thù của hoạt động này sẽ giảm intraoperative xuất huyết di chứng. | 486 B. Ch. Golematis I. P. Gomatos M. M. Konstadoulakis severe complications. Although the necessity for intraoperative transfusions is increased compared to the open technique paying particular attention during the ligation of large splenic vessels and attaining familiarity with the peculiarities of this operation will diminish intraoperative haemorrhagic sequelae. Furthermore the calculated steep learning curve of the initial 20 cases as estimated in a paediatric facility 29 can be easily exceeded in specialised laparoscopic centres where this procedure is routinely performed. Despite the fact that the indications of laparoscopic splenectomy are more or less the same as those of open splenectomy splenic size constitutes an important restraining 30 31 Splenic size over 30 cm along the longitudinal axis of the organ has been considered a relative contraindication for the laparoscopic Additionally in a recent study 33 the incidence of splenectomy-associated complications has been shown to increase in relation to the splenic size with massive splenomegaly as defined by a spleen weighing more than 1000 g leading to a 10 overall complication rate as compared with only a complication rate for patients with a spleen weighing less than 1000 g. Nevertheless other studies34 suggest that laparoscopic splenectomy can be safely applied in patients with significantly enlarged spleens especially if a hand-assisted laparoscopic approach is The reported overall complication rates following laparoscopic splenectomy range from 0 to 24 . These findings are similar to the ones published in the series of open However the primary difference between laparoscopic and open splenectomy resides in the type of complications. Most laparoscopic series reported minor complications such as ileus 30 seromas of the port sites 32 39 40 and pleural effusion 30 39 41 while in more than 450 laparoscopic cases collected only one series reported
