Short- and long-term outcomes of 486 consecutive laparoscopic splenectomy in a single institution

Abstract

Since its introduction in 1991, laparoscopic splenectomy (LS) has become the gold standard in elective spleen surgery in many centres. However, there still lack the report of long-term outcomes of LS with the large-scale cases. The aim of the present study was to analyze the short- and long-term outcomes of LS in a single institution over 16 years, and to compare the perioperative outcomes of totally laparoscopic splenectomy (TLS) and hand-assisted laparoscopic splenectomy (HALS) for splenomegaly. Between November 2002 and December 2018, 486 consecutive patients undergoing elective LS were enrolled in this study, including 222 TLS and 264 HALS. The intraoperative, postoperative, and follow-up data were retrospectively analyzed. The 5 most common indications were hypersplenism (71.0%), immune thrombocytopenia (14.8%), splenic benign tumor (4.5%), splenic cyst (2.9%), and splenic malignant tumor (2.9%). The mean operative time, intraoperative blood loss, and length of stay were 149.4 ± 63.3 minutes, 230.1 ± 225.1 mL, and 6.7 ± 3.2 days, respectively. The morbidity, mortality, reoperation, and conversion rate were 23.0%, 0, 0.4%, and 1.9%, respectively. Portal vein system thrombosis (PVST) was the most frequent complication with an incidence of 19.8%. The incidence of PVST in HALS was higher than that in TLS (23.9% vs 14.9%, P = .013). Compared with TLS, HALS had a shorter operative time ( P = .000), lower intraoperative blood loss ( P = .000), comparable conversion rate ( P = .271), and morbidity ( P = .922) for splenomegaly > 17.0 cm. During the follow-up period, the overall respond rate for immune thrombocytopenia was 77.8%, and the esophagogastric variceal bleeding rate was 6.9% in 320 patients with hypersplenism secondary to hepatic cirrhosis. LS is a safe, feasible, and effective procedure with satisfactory short- and long-term outcomes. HALS is a reasonable technique in patients with massive spleens.

A Glimpse into the Role and Effectiveness of Splenectomy for Isolated Metachronous Spleen Metastasis of Colorectal Cancer Origin: Long-Term Survivals Can Be Achieved

“…The oncological safety of a minimally invasive approach for spleen malignancies (including SM) was recently demonstrated [102]. A minimally invasive splenectomy is associated with low morbidity rates and almost nil mortality rates for both benign and malignant pathologies [102,103], although a malignant pathology is a risk factor for postoperative morbidity [104].…”

Diagnostic accuracy of D-dimer in patients at high-risk for splanchnic vein thrombosis: A systematic review and meta-analysis

“…For instance, Violi et al described a prevalence of PVT of 17% in cirrhotic patients overall, corresponding to 11.3% in Child-Pugh A class, 24.8% in Child-Pugh B and 17.2% in Child-Pugh C [38]. A recently published study evaluating 486 consecutive laparoscopic splenectomies reported post-operative portal vein system thrombosis in 19.8% of cases [39]. The high prevalence of SVT together with the observational design of the included studies indicate that there might be a bias in the enrolled population, suggesting that D-dimer was tested in patients more likely to develop SVT among those at high risk.…”