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01.06.2014 | Original Article | Ausgabe 5/2014

Langenbeck's Archives of Surgery 5/2014

Value and risk of laparoscopic surgery in hemophiliacs—experiences from a tertiary referral center for hemorrhagic diatheses

Zeitschrift:
Langenbeck's Archives of Surgery > Ausgabe 5/2014
Autoren:
Philipp Lingohr, Safia Bensoukehal, Hanno Matthaei, Jonas Dohmen, Jennifer Nadal, Tim Oliver Vilz, Arne Koscielny, Johannes Oldenburg, Jörg Christoph Kalff, Georg Goldmann

Abstract

Purpose

Laparoscopic surgery (LS) is gaining popularity worldwide because of benefits like faster recovery, earlier hospital discharge, and better cosmetic results. In hemophiliacs, surgery in general harbors an increased risk for severe complications. Whether LS or conventional surgery (CS) should be recommended in these patients is controversial and therefore the issue of our present study.

Methods

We performed a retrospective matched-pair analysis including laparoscopically operated non-hemophiliacs (LONH), laparoscopically operated hemophiliacs (LOH), and conventionally operated hemophiliacs (COH) concerning duration of surgery, drainages, hospital stay, complications, factor use (VIII, IX, and X), and blood values. Mann-Whitney U test was used (significance level P = 0.05).

Results

No significant differences were found in duration of surgery and drains in laparoscopically or conventionally operated hemophiliacs versus matched pairs. Complication rate did not differ among the different groups.
Concerning the total duration of hospital stay (t-DHOS) and the postoperative duration of hospital stay (p-DHOS), there was no statistical difference between LOH versus matched LONH. However, in COH versus matched LOH, a longer time was required for preparation and recovery (t-DHOS, P = 0.04; p-DHOS, P < 0.001).
Also, the median factor supply perioperatively including the day of surgery did not differ between laparoscopically versus conventionally operated hemophiliacs.

Conclusions

Our study underscores the safety and benefits of laparoscopic procedures in hemophiliacs by showing a significantly shorter hospital stay for these patients resulting in reduced therapeutic costs and a faster mobilization. Still, the surgical and perioperative management of hemophiliacs continues to be a challenge requiring an experienced interdisciplinary team.

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