Bing Peng, PhD MD Prof, Yunqiang Cai, MD, Jin Zhou, MD, Xiaodong Chen, PhD MD, Yichao Wang, MD, Zhong Wu, MD. Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University
Objective: Laparoscopic splenectomy has become the standard procedure for the normal to moderately enlarged spleens. We carried out this study in order to investigate the safety, feasibility, and effectiveness of laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis.
Methods and procedures: We performed a retrospective chart review of 24 cases of laparoscopic splenectomy (group 1), 24 cases of open splenectomy (group 2) for hypersplenism secondary to liver cirrhosis, and 68 cases of laparoscopic splenectomy for immune thrombocytopenic purpura (group 3). We carried out comparisons between groups 1 and 2 and groups 1 and 3 in terms of demographic, intraoperative, postoperative variables, and changes in blood counts and liver function.
Results: Patients in groups 1 and 2 had comparable demographic characteristics, but those in group 1 had less estimated blood loss, fewer complications, and shorter duration of oral intake, and they required less analgesia and post-hospital care. In both groups, leukocyte and platelet counts increased significantly and transaminase and total bilirubin decreased, but not significantly, and there was no significant difference between the two groups. Compared with group 3, patients in group 1 were older, had lower hemoglobin levels and leukocyte counts, and a poorer Child-Pugh class, required more operation time, and suffered more estimated blood loss; however, there were no statistically significant differences in terms of conversion rates, transfusion rates, complication rates, and postoperative course.
|Group 1||Group 2||Group 3||P1 value||P2 value|
|Operation time (min)||224 ||186 ||167 ||NS||<0.001|
|Blood loss (ml)||162 ||421 ||110 ||0.021||0.030|
|Spleen weight (g)||1405 ||1243 ||415 ||NS||<0.001|
|RBC Transfusion||8.3% (2/24)||37.5% (9/24)||11.8% (8/68)||0.016||NS|
|Conversions||4.2% (1/24)||NA||3.0% (2/68)||NA||NS|
|Hospital stay (days)||7.5 [1.7]||9.9 [3.4]||7.8 [3.1]||0.014||NS|
|Analgesic||16.7% (4/24)||58.3% (14/24)||19.1% (13/68)||0.003||NS|
|Oral intake (days)||1.6 [1.0]||3.2 [0.9]||1.3 [0.6]||<0.001||NS|
|Complications||12.5% (3/24)||41.7% (10/24)||14.7% (10/68)||0.028||NS|
P1 value: comparison between group 1 and group 2; P2 value: comparison between group 1 and group 3; NA: not applicable; NS: not significant
Conclusions: Laparoscopic splenectomy is a safe, feasible, and effective procedure for hypersplenism secondary to liver cirrhosis.
Program Number: S099