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. 2019 Apr;33(4):1298-1303.
doi: 10.1007/s00464-018-6394-7. Epub 2018 Aug 27.

Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear

Reuben D Shin  1 , Roger Lis  1 , Nicholas R Levergood  1 , David C Brooks  1 , Brent T Shoji  1 , Ali Tavakkoli  2
Affiliations

Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear

Reuben D Shin et al. Surg Endosc. 2019 Apr.

Abstract

Background: The benefits of laparoscopic splenectomy (LS) over open splenectomy (OS) for normal-sized spleens have been well documented. However, the role of laparoscopy for moderate and massive splenomegaly is debated.

Methods: A retrospective review of patients undergoing elective splenectomy at one institution from 1997 to 2017 was conducted. Moderate and massive splenomegaly was defined as splenic weight of 500-1000 g and greater than 1000 g, respectively. We performed a 1:2 matching of laparoscopic to open splenectomy to control for differences in splenic weight. Differences in perioperative morbidity (infection, thromboembolism, reoperation, readmission), intraoperative factors (blood loss, operative time), length of stay, and mortality were examined.

Results: A total of 491 elective splenectomies were identified. 268 cases were for splenic weights greater than 500 g. After a 1:2 matching of LS:OS, we identified 22 LS and 44 matched OS for moderate splenomegaly. The LS group had longer mean operative times (178 vs. 107 min, p < 0.01), with similar length of stay and blood loss. For massive splenomegaly, 26 LS were identified and matched to 52 OS. LS had longer mean operative times (171 vs. 112 min, p < 0.01) and higher readmission rates (27% vs. 6%, p < 0.05). Other factors and outcomes did not differ between LS and OS for moderate or massive splenomegaly. The conversion rate for LS was higher for massive versus moderate splenomegaly, but was not statistically significant (35% vs. 14%, p = 0.09).

Conclusions: LS for moderate and massive splenomegaly is associated with longer operative times. Other perioperative outcomes were comparable to OS, with no demonstrated benefits for LS. Although LS may be a feasible approach to moderate and massive splenomegaly, its benefits require further clarification in this patient population.

Keywords: Laparoscopic splenectomy; Massive splenomegaly; Moderate splenomegaly; Splenectomy; Splenomegaly.

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References

    1. Delaitre B, Maignien B, Icard P (1992) Laparoscopic splenectomy. Br J Surg 79(12):1334 - DOI - PubMed
    1. Friedman RL, Fallas MJ, Carroll BJ, Hiatt JR, Phillips EH (1996) Laparoscopic splenectomy for ITP. The gold standard. Surg Endosc 10(10):991–995 - DOI - PubMed
    1. Baccarani U, Donini A, Terrosu G, Pasqualucci A, Bresadola F (1999) Laparoscopic splenectomy for haematological diseases: review of current concepts and opinions. Eur J Surg 165(10):917–923 - DOI - PubMed
    1. Musallam KM, Khalife M, Sfeir PM et al (2013) Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg 257(6):1116–1123 - DOI - PubMed
    1. Park A, Marcaccio M, Sternbach M, Witzke D, Fitzgerald P (1999) Laparoscopic vs open splenectomy. Arch Surg 134(11):1263–1269 - DOI - PubMed

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