Refining the Selection Criteria for Laparoscopic Versus Open Splenectomy for Splenomegaly
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
BACKGROUND: Although laparoscopic splenectomy is considered the procedure of choice for patients with normal-sized spleens, the benefits are less clear in the presence of splenomegaly, which represents a heterogeneous patient population with a variety of underlying diseases. The aim of this study was to compare the outcomes of laparoscopic (LS) and open splenectomy (OS) for spleens between 15 and 25 cm in length in order to identify strategies for patient selection for the laparoscopic approach. STUDY DESIGN: The medical records of concurrent patients undergoing splenectomy for splenomegaly (>15 cm in the long axis) from 2000 to 2005 were reviewed at two hospitals. At one hospital, LS was performed unless the spleen was >25 cm in length, while the other hospital used OS exclusively. Demographic, intraoperative, and postoperative variables were compared for patients potentially eligible for LS. Data are expressed as median (interquartile range) and were analyzed by using nonparametric tests. A value P < 0.05 was considered statistically significant. RESULTS: Sixty-five laparoscopic and 25 open splenectomies were performed at the two hospitals, of which 34 were for splenomegaly. Five open cases involved spleens >25 cm and were excluded, leaving 18 LS (13 hand assisted) and 11 OS for further analysis. The groups were similar in comorbidity score, spleen length, hematologic diagnosis, and intraoperative blood loss. The open group was younger, included more females, and had a shorter operative time. Time to oral intake (1 vs. 2 days; P = 0.04) and length of hospital stay (3 vs. 6 days; P = 0.01) were shorter in the LS group. Postoperative complications occurred in 7 (39%) LS and 6 (55%) OS patients (P = 0.47); these were major in 3 LS patients and 1 OS patient (P = 1.0). All 3 major complications after LS occurred in the 3 patients with myelofibrosis and involved a conversion or reoperation by laparotomy for bleeding. CONCLUSIONS: Laparoscopic splenectomy confers benefit for most patients with splenomegaly between 15 and 25 cm, as it is associated with faster time to oral intake and a shorter hospital stay. Major morbidity after laparoscopic splenectomy was mostly related to surgery for myelofibrosis. These patients did not derive any benefit from the laparoscopic approach due to bleeding complications, requiring a conversion or relaparotomy.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it