Trends in Splenectomy: Where Does Laparoscopy Stand?

Abstract

Background and Objectives:Laparoscopic splenectomy (LS) has been shown to offer superior outcomes when compared to open splenectomy (OS). Despite the potential advantages associated with the minimally invasive technique, laparoscopy appears to be underused. We sought to evaluate the nationwide trends in LS.Methods:The Nationwide Inpatient Sample (NIS) database was queried for both OS and LS procedures performed from 2005 through 2010. Partial splenectomies and those performed for traumatic injury, vascular anomaly, or as part of a pancreatectomy were excluded. The included cases were examined for age of the patient and comorbid conditions. We then evaluated the postoperative complications, overall morbidity, mortality, and length of hospital stay.Results:A total of 37,006 splenectomies were identified. Of those, OS accounted for 30,108 (81.4%) cases, LS for 4,938 (13.3%), and conversion to open surgery (CS) for 1,960 (5.3%). The overall rate of morbidity was significantly less in the LS group than in the OS group (7.4% vs 10.4%; P < .0001). The LS group had less mortality (1.3% vs 2.5%, P < .05) and a shorter length of stay (5.6 ± 8 days vs 7.5 ± 9 days).Conclusions:Despite the benefits conferred by LS, it appears to be underused in the United States. There has been an improvement in the rate of splenectomies completed laparoscopically when compared to NIS data from the past (8.8% vs 13%; P < .05). The conversion rate is appreciably higher for LS than for other laparoscopic procedures, suggesting that splenectomies require advanced laparoscopic skills and that consideration should be given to referring patients in need of the procedure to appropriately experienced surgeons.

Laparoscopic Splenectomy in the Treatment of Hematological Diseases of the Spleen

“…Most of the operatedpatients had a diagnosis of ITP-a 72 (87.8%), eight patients (9.8%) were diagnosed withspherocytosis, and two (2.4%) had diagnosis of AIHA. The average BMI was 24.3 kg/m 2 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The average platelet count was 81.8 (25-240) x 10 9 /L.…”

Analysis of the surgical treatment of the patients operated on by using laparoscopic and classic splenectomy due to benign disorders of the spleen

“…In the US National Register, between 2005 and 2010, 37006 splenectomies were recorded, showing a worrying percentage of conversions of 22.5-33.99%, with very few patients being treated with laparoscopic technique at around 13.3% (10). Some authors point to a small conversion rate into an open procedure with a percentage of around 0-4% depending on the type of intraoperative complication when it comes to increased intraoperative bleeding and when splenomegaly is present (9,11).…”

Diagnostic vs therapeutic splenectomy: the trend in tertiary center

“…3,8,11 Laparoscopic splenectomy is increasingly being used due to less complication rate when compared to open splenectomy. 12,13 In recent years indications of splenectomy are changing worldwide and spleen preservation procedures The international data shows decreasing trend of splenectomy for various indications due to new interventional and diagnostic modalities. 2 The most common indication for splenectomy in most institution was trauma, but it has significantly reduced due to the non-operative management of splenic injury.…”