Laparoscopic Versus Open Splenectomy for Hematologic Diseases – A 10-year, Single-center Experience

INTRODUCTION: Although laparoscopic splenectomy (LS) has become widely accepted as the approach of choice for the surgical treatment of hematologic diseases, some areas still remain controversial. We present a 10-year, single institution experience with splenectomy for non-traumatic diseases to evaluate the safety and feasibility of laparoscopic versus open (OS) technique.
METHODS: A retrospective review of 286 consecutive patients that underwent splenectomy for hematologic disease from January, 1997 to January, 2007 was performed. Patient demographics, indication, operative technique and time, spleen weight, length of hospital stay (LOS), peri-operative morbidity and mortality were recorded. The two operative approaches were categorized based on an intention-to-treat basis.
RESULTS: Two hundred and five patients underwent open splenectomy and 81 patients underwent a laparoscopic approach. The two groups were comparable for sex and BMI. The LS group was younger (48 vs. 54 years P < 0.0028). The most common underlying disease was malignancy (45%) in the OS patients and ITP (48%) in the LS patients. Of the 65 total ITP patients, 2 had accessory spleens removed during LS, and there were no cases of recurrent disease requiring re-operation. Eleven conversions from LS to OS occurred, mostly due to hemorrhage, and 3 of these patients had massive splenomegaly. Overall there were 90 spleens weighing greater than 1000 gms with 29% in OS group (P < 0.001). Although LS was associated with significantly longer operative time (149 vs. 108 min P < 0.0001), it carried a lower peri-operative morbidity and mortality (17.6% vs. 4.9%, P = 0.0098 and 2.4% vs. 0%, respectfully) and shorter LOS (4 days vs. 3 days, P < 0.001).
CONCLUSION: Laparoscopic splenectomy is the preferred surgical approach for treatment of benign as well as malignant hematologic disorders. Massive splenomegaly is a relative contraindication that requires an experienced surgeon, otherwise a hand-assisted laparoscopic or open approach should be considered.

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