Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear

Shin, Reuben D; Lis, Roger T.; Levergood, Nicholas; Brooks, David; Shoji, Brent; Tavakkoli, Ali

doi:10.1007/s00464-018-6394-7

Cited by 22 publications

(15 citation statements)

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“…The median global conversion rate in the LS subgroup was 19.56% [11.11; 25]. The highest conversion rate was that of Boddy et al [14] with 54.55% [mean spleen weight: 2000 g (1000-3530)], followed by that of Shin et al [20] with 34.62% in the subgroup of massive splenomegaly [mean splenic weight of 1754.9 g (1032-3800)], and Targarona et al [13] with 23.81% [mean weight of 1616 ± 651 g (1000-2950)]. However, in a cohort with 25 patients, Cassacia et al [21] reported a 0% conversion rate [mean splenic diameter of 24.0 ± 3.3] in cases of massive splenomegaly.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

et al. 2020

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Objectives To review the evidence regarding the outcomes of laparoscopic techniques in cases of splenomegaly. Background Endoscopic approaches such as laparoscopic, hand-assisted laparoscopic, and robotic surgery are commonly used for splenectomy, but the advantages in cases of splenomegaly are controversial. Review methods We conducted a systematic review using PRISMA guidelines. PubMed/MEDLINE, ScienceDirect, Scopus, Cochrane Library, and Web of Science were searched up to February 2020. Results Nineteen studies were included for meta-analysis. In relation to laparoscopic splenectomy (LS) versus open splenectomy (OS), 12 studies revealed a significant reduction in length of hospital stay (LOS) of 3.3 days (p = \0.01) in the LS subgroup. Operative time was higher by 44.4 min (p \ 0.01) in the LS group. Blood loss was higher in OS 146.2 cc (p = \0.01). No differences were found regarding morbimortality. The global conversion rate was 19.56%. Five studies compared LS and hand-assisted laparosocpic splenectomy (HALS), but no differences were observed in LOS, blood loss, or complications. HALS had a significantly reduced conversion rate (p \ 0.01). In two studies that compared HALS and OS (n = 66), HALS showed a decrease in LOS of 4.5 days (p \ 0.01) and increase of 44 min in operative time (p \ 0.01), while OS had a significantly higher blood loss of 448 cc (p = 0.01). No differences were found in the complication rate. Conclusion LS is a safe approach for splenomegaly, with clear clinical benefits. HALS has a lower conversion rate. Higher-quality confirmatory trials with standardized splenomegaly grading are needed before definitive recommendations can be provided. Prospero registration number: CRD42019125251.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

et al. 2020

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“…Sin embargo, cuando se comparan esplenectomías realizadas sobre bazos de tamaño normal y aquellos con esplenomegalias masivas sí existen diferencias, una de ellas lógica como puede ser el tiempo operatorio (112 minutos para los bazos de tamaño normal y 171 para las esplenomegalias masivas) y en nuestro caso superior, 220 minutos, ya que el objetivo es evitar un sangrado por desgarro parenquimatoso o lesión vascular del pedículo o sus ramas que obliguen a la conversión y por lo tanto lo más importante sobre todo cuando se trata de los primeros casos realizados es la minuciosidad en los diversos tiempos operatorios. La otra diferencia son los reingresos que también resultaron ser superiores para las esplenomegalias masivas (27% vs 6%) (9) .…”

Section: Discussionunclassified

Esplenectomía Laparoscópica en Esplenomagalia Masiva Por Linfoma No Hodgkin De Zona Marginal.

Tristant

González

2021

rmu

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Introducción: si bien la esplenectomía laparoscópica en esplenomegalias masivas y supramasivas constituye un desafío técnico, su realización es factible y segura en centros con equipos con experiencia en cirugía laparoscópica.Objetivo: presentar el primer caso de esplenectomía laparoscópica en esplenomegalia masiva realizada en Uruguay.Caso clínico: se trata de una paciente de 70 años portadora de una pancitopenia periférica, esplenomegalia masiva y diagnóstico realizado por punción de médula ósea de neoplasia linfoproliferativa tipo B de bajo grado, a quien se le indicó la esplenectomía con fines diagnósticos y terapéuticos. La paciente se operó en decúbito lateral derecho a 15 grados, los trócares se colocaron bajo visión directa adaptados al tamaño del bazo que se extendía desde el diafragma hasta el estrecho superior de la pelvis. Se realizó la esplenectomía en un tiempo de 220 minutos, extrayéndose la pieza íntegra y sin haberla colocado en bolsa a través de un hemi Pfannenstiel, protegiendo la pared con un retractor de heridas quirúrgicas. No presentó complicaciones, fue dada de alta a las 48 horas. El hemograma realizado a las 24 horas demostró un aumento de las cifras de todas las series celulares y el informe anatomopatológico diagnosticó un linfoma no Hodgkin de zona marginal.Discusión: la esplenectomía laparoscópica en esplenomegalias masivas requiere de un mayor tiempo quirúrgico, aunque las pérdidas sanguíneas y la estadía hospitalaria son menores en comparación a los procedimientos convencionales, presentando una morbilidad similar. En la experiencia inicial de los equipos quirúrgicos se reporta un porcentaje de conversiones y reingresos cercanos al 30%.

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“…Another indication for conversion to open surgery is the enlarged spleen volume or splenomegaly because splenomegaly cannot allow adequate surgical exposure, suitable location of ports and maneuverability during the laparoscopic and robotic splenectomy which raises the risk of hemorrhage (20)(21)(22)(23). On the other hand, despite longer operative time of laparoscopic splenectomy, Pattenden et al, Owera et al and Silecchia et al suggest laparoscopic splenectomy in patients with splenomegaly after an effective learning curve (15,24,25).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

et al. 2020

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Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear

Cited by 22 publications

References 20 publications

Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

Esplenectomía Laparoscópica en Esplenomagalia Masiva Por Linfoma No Hodgkin De Zona Marginal.

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

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