Laparoscopy Splenectomy for Massive Splenomegaly

Wang, Bo; Wu, Heshui; Wang, Guobin; Tao, Kaixiong

doi:10.3109/08941939.2012.691604

Cited by 11 publications

(5 citation statements)

References 13 publications

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“…Although the European Association for Endoscopic Surgery guidelines consider portal hypertension as an absolute contraindication for LS (33), several publications since then reported on the safety of the method in patients with cirrhosis and portal hypertension (24,(34)(35)(36)(37)(38).…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Moris

Dimitriou

Grınıatsos

2017

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Section: Resultsmentioning

confidence: 99%

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Moris

Dimitriou

Grınıatsos

2017

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“…The LS versus OS group included 12 studies [5,8,[12][13][14][15][16][17][18][19][20][21] (one ambidirectional cohort, five prospective cohorts, and six retrospective cohorts, with a total of 652 patients). The HALS versus OS [22,23] group included two studies (one retrospective cohort and one prospective randomized control trial with a total of 398 patients), and the LS versus HALS [8,[24][25][26][27] group included five studies (four retrospective cohorts and one prospective cohort, with a total of 306 patients).…”

Section: Study Characteristic and Quality Assessmentmentioning

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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“…Additionally, immunological mechanisms leading to the maintenance of splenic immunological function might be involved [12]. Splenectomy is characterized by surgical wounds; however, general anesthesia and postoperative infection may also exacerbate the existing liver damage in WD patients, enhancing the potential risk of hepatic encephalopathy and even of life-threatening liver failure [7,[15][16][17]. Meanwhile, studies have ensured the long-term efficacy of PSE in alleviating hypersplenism and reducing complications in patients with hepatitis B and C virus-related liver cirrhosis, including increasing the blood cell counts and improving the liver function [6,18].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Hypersplenism in Wilson's Disease by Partial Splenic Embolization

Chen

Yuan-cheng

et al. 2017

Journal of Investigative Surgery

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Aim: Hypersplenism can occur in patients with Wilson's disease (WD). Surgical splenectomy is a conventional treatment for this condition; however, emotional and neurological deterioration may follow splenectomy. In recent years, partial splenic embolization (PSE) has been increasingly performed as a nonsurgical alternative treatment for hypersplenism. The aim of this study was to evaluate the effectiveness and safety of PSE compared with splenectomy in the treatment of hypersplenism in WD patients. Methods: Fifty WD patients with hypersplenism were randomly divided into two groups (group A and group B), each including 25 patients. Patients in groups A and B were treated with PSE and splenectomy, respectively. Data were collected on the clinical efficacy of each procedure, adverse reactions, hematologic and blood chemistry test results, and abdominal computed tomography (CT) scan findings (group A only). Results: Marked improvements in the platelet and leukocyte counts after PSE and splenectomy were observed in all patients. PSE was associated with improved liver function without severe complications, and no significant changes in emotional and neurological symptoms were observed. In contrast, seven WD patients suffered neurological deterioration after splenectomy. Conclusions: Hypersplenism in WD patients was successfully treated by PSE, which appears to be a safe and effective alternative treatment for WD-induced hypersplenism.

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Laparoscopy Splenectomy for Massive Splenomegaly

Abstract: LS for treatment of massive splenomegaly is a feasible, effective, and safe surgical technique. Hypersplenism secondary to portal hypertension and liver cirrhosis are not supposed to be considered absolute contraindications to LS.

Cited by 11 publications

References 13 publications

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

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

Successful Treatment of Hypersplenism in Wilson's Disease by Partial Splenic Embolization

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