Reuben D Shin, Ali Tavakkoli. Brigham and Women’s Hospital
Objective: To evaluate the operative and clinical outcomes in laparoscopic versus open splenectomy for moderate and massive splenomegaly.
Background: The benefits of laparoscopic splenectomy (LS) over open splenectomy (OS) for normal sized spleens have been well established and it is considered the standard of care at many centers. However the role of laparoscopy for moderate and massive splenomegaly is debated.
Method: A retrospective review of patients undergoing splenectomy for non-trauma indications at one institution from 1997-2013 was conducted. Moderate and massive splenomegaly was defined as splenic weight of 500g to 1000g and greater than 1000g, respectively. After an analysis of the overall cohort, we performed a 1:2 matching of laparoscopic to open splenectomy to control for differences in splenic weight between the two groups. Differences in perioperative morbidity (infection, thrombo-embolism, reoperation, readmission), intra-operative factors (bleeding, operative time), length of stay, and mortality between LS and OS groups were examined for moderate and massive splenomegaly.
Results: A total of 420 elective splenectomies were identified (155 LS and 275 OS). We identified 45 LS and 178 OS for splenomegaly (spleen weight >500g). Comparing these 2 cohorts, OS was associated with shorter OR time (106 vs. 176 min; p<0.01), We then performed a 1:2 matching of LS vs. OS. In patients with moderate splenomegaly, we identified 18 LS and 36 matched OS cases. The LS group had longer mean operative times (171 vs 107 minutes, p=0.001), with similar length of stay and blood loss. In patients with massive splenomegaly, 23 LS were identified and matched to 46 OS. The LS group had longer mean operative times (175 vs 106 minutes, p=0.001), higher rates of thrombo-embolic complications (5/23 vs 2/46, p=0.04), and greater readmission rates (7/23 vs 3/46, p=0.01). Overall morbidity and mortality did not differ between LS and OS for moderate or massive splenomegaly. The conversion rate from laparoscopic to open in the LS groups was higher for massive vs. moderate splenomegaly (8/23 vs 1/18, p=0.05).
Conclusions: The benefits of LS over OS in normal sized spleens do not appear to be evident in patients with moderate or massive splenomegaly. In addition to the lack of benefit of LS for moderate splenomegaly, massive splenomegaly was associated with more perioperative morbidities. The advantages of LS in this group of patients remain to be unclear, and requires further studies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88275
Program Number: S133
Presentation Session: Solid Organ Session
Presentation Type: Podium