Yan-Nan Bai1, Hui Jiang, Pankaj Prasoon. 1. Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. scalpel-bai@hotmail.com
Abstract
BACKGROUND: Due to changes in surgical trends, laparoscopic splenectomy (LS) has become the standard approach for most splenectomies performed for hematological disorders, barring any contraindications. The perioperative outcomes of LS for this indication have not been updated for several years. Controversy still surrounds whether LS should be performed for massive splenomegaly. The purpose of this meta-analysis was to evaluate the perioperative outcomes of laparoscopic splenectomy for hematological disorders. METHODS: Literature searches were conducted to identify studies comparing the perioperative outcomes of the laparoscopic and open approaches for hematological disorders. The results were pooled by using standard meta-analysis methods. RESULTS: Thirty-eight studies with a total of 2,914 patients comparing LS to open splenectomy (OS) for hematological disorders were identified. Mortality was low in both groups. The pooled complications of the LS group were significantly fewer than those of the OS group (-0.11, p < 0.001), and the NNT was 9 (95 % confidence interval, 6-20). For massive spleens, a similar result was observed (-0.12, p = 0.009). Accessory spleen resection and blood loss also were comparable between the two approaches. Additionally, LS was associated with longer operative times (57.38 min, p < 0.00001) and shorter hospital stays (2.48 days, p < 0.00001). CONCLUSIONS: LS is preferred compared to OS, based on lower complication rates and better handling of comorbid conditions. LS is associated with shorter hospital stays but longer operative times. We conclude that LS may be considered an acceptable option even in cases of a massive spleen. To strengthen the clinical evidence, more high-quality clinical trials on different issues are necessary.
BACKGROUND: Due to changes in surgical trends, laparoscopic splenectomy (LS) has become the standard approach for most splenectomies performed for hematological disorders, barring any contraindications. The perioperative outcomes of LS for this indication have not been updated for several years. Controversy still surrounds whether LS should be performed for massive splenomegaly. The purpose of this meta-analysis was to evaluate the perioperative outcomes of laparoscopic splenectomy for hematological disorders. METHODS: Literature searches were conducted to identify studies comparing the perioperative outcomes of the laparoscopic and open approaches for hematological disorders. The results were pooled by using standard meta-analysis methods. RESULTS: Thirty-eight studies with a total of 2,914 patients comparing LS to open splenectomy (OS) for hematological disorders were identified. Mortality was low in both groups. The pooled complications of the LS group were significantly fewer than those of the OS group (-0.11, p < 0.001), and the NNT was 9 (95 % confidence interval, 6-20). For massive spleens, a similar result was observed (-0.12, p = 0.009). Accessory spleen resection and blood loss also were comparable between the two approaches. Additionally, LS was associated with longer operative times (57.38 min, p < 0.00001) and shorter hospital stays (2.48 days, p < 0.00001). CONCLUSIONS:LS is preferred compared to OS, based on lower complication rates and better handling of comorbid conditions. LS is associated with shorter hospital stays but longer operative times. We conclude that LS may be considered an acceptable option even in cases of a massive spleen. To strengthen the clinical evidence, more high-quality clinical trials on different issues are necessary.
Authors: Kent W Kercher; Brent D Matthews; R Matthew Walsh; Ronald F Sing; Charles L Backus; B Todd Heniford Journal: Am J Surg Date: 2002-02 Impact factor: 2.565
Authors: R Pugliese; F Sansonna; I Scandroglio; D Maggioni; G C Ferrari; S Di Lernia; A Costanzi; G Grillo; S Cimbanassi; O Chiara Journal: Int Surg Date: 2006 Mar-Apr
Authors: Manuela V Sapucahy; Joel Faintuch; Cláudio J C Bresciani; Pedro L Bertevello; Angelita Habr-Gama; Joaquim José Gama-Rodrigues Journal: Rev Hosp Clin Fac Med Sao Paulo Date: 2003-11-11
Authors: Carlos Rodriguez-Otero Luppi; Eduardo M Targarona Soler; Carmen Balague Ponz; Juan Pablo Pantoja Millán; Victor Turrado Rodriguez; Jose Luis Pallares Segura; Jesus Bollo Rodriguez; Manel Trias Folch Journal: World J Surg Date: 2017-02 Impact factor: 3.352