DOI: http://dx.doi.org/10.18203/2349-2902.isj20174637

Splenectomy for haematological diseases: comparison between laparoscopic and open procedures

Emad Gomaa, Magdy Khalil

Abstract


Background: In some hematological diseases, the spleen may become enlarged, inflamed and causes destruction of normal blood elements. Laparoscopic splenectomy (LS) was first prescribed in 1991 by Delaitre et al and since that date, it gained a steadily increasing worldwide agreement as an option for splenectomy in patients with hematological diseases. It was reported that this can be performed safely and effectively, with lower incidence of morbidity and mortality. The objective of the study was to compare laparoscopic with open splenectomy as regard its benefits and hazards in haematological diseases.

Methods: This prospective study had been conducted in General Surgery Department, Sohag Faculty of Medicine. The study included patients with haematological diseases indicated for elective splenectomy, during the period from January 2015 to June 2017. Twenty patients were included for open surgery (OS) and 20 cases were included for laparoscopic splenectomy (LS).

Results: Surgical time was significantly longer in LS than OS group. There was significant correlation between surgical time and splenic size in both groups. Most of the LS patients had been operated upon using the anterior approach (65%). Hospital stay after operation in the LS group was much less than the OS group. Return of off-bed activities, bowel movements, oral intake and drain removal were longer but not significantly different compared to LS figures.

Conclusions: Laparoscopic splenectomy for haematological indications can be done safely for the properly selected patients with less blood loss and hospital stay but it requires more operative time as compared to conventional splenectomy.


Keywords


Hematological, Laparoscopic, Splenectomy

Full Text:

PDF

References


Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review. In Vivo. 2017;31(3):291-302.

Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med. 1991;20(44):2263.

Sotomayor-Ramirez RK. Efficacy and safety of laparoscopic splenectomy: review of 14 adult cases using the lateral approach. Bol Asoc Med P R. 2009;101(2):43-9.

Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, et al. Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg. 1998;228(4):568-78.

Khirallah MG, Eldessoky NE, Elbatarny AM, Elsawaf ME. Laparoscopic splenectomy in children with benign hematological diseases: Leaving nothing behind policy. J Indian Assoc Pediatr Surg. 2016;21(1):14-8.

Choi SH, Kang CM, Hwang HK, Lee WJ. Reappraisal of anterior approach to laparoscopic splenectomy: technical feasibility and its clinical application. Surg Laparosc Endosc Percutan Tech. 2011;21(5):353-7.

Trias M, Targarona EM, Balague C. Laparoscopic splenectomy: an evolving technique. A comparison between anterior and lateral approaches. Surg Endosc. 1996;10(4):389-92.

Podevin G, Victor A, De Napoli S, Heloury Y, Leclair MD. Laparoscopic splenectomy: comparison between anterior and lateral approaches. J Laparoendosc Adv Surg Tech A. 2011;21(9):865-8.

Kuriansky J, Ben Chaim M, Rosin D, Haik J, Zmora O, Saavedra P, et al. Posterolateral approach. An alternative strategy in laparoscopic splenectomy. Surg Endosc. 1998;12(6):898-900.

Gossot D, Fritsch S, Celerier M. Laparoscopic splenectomy: optimal vascular control using the lateral approach and ultrasonic dissection. Surg Endosc. 1999;13(1):21-5.

Macedo M, Lina Wang, Tatiana Cristina, Oliveira M. Laparoscopic Splenectomy in the Treatment of Childhood Hematologic Disorders. Bras J Video-Sur. 2010;3(4):195-9.

Al-Khuzaie J, Bin Dayna K, AWM AW. Laparoscopic Splenectomy versus Conventional Splenectomy. Bahrain Medical Bulletin. 2002;24(2).

Ardestani A, Tavakkoli A. Laparoscopic versus open splenectomy: the impact of spleen size on outcomes. J Laparoendosc Adv Surg Tech A. 2013;23(9):760-4.

Sapucahy MV, Faintuch J, Bresciani CJ, Bertevello PL, Habr-Gama A, Gama-Rodrigues JJ. Laparoscopic versus open splenectomy in the management of hematologic diseases. Rev Hosp Clin Fac Med Sao Paulo. 2003;58(5):243-9.

Mahatharadol V, Meesiri S. Results of laparoscopic splenectomy for immune thrombocytopenic purpura. J Med Assoc Thai. 2006;89(6):821-5.

Su CH, Yin TC, Huang CJ, Fan WC, Hsieh JS. Laparoscopic splenectomy for splenomegaly using a homemade retrieval BAG. Wideochir Inne Tech Maloinwazyjne. 2013;8(4):327-33.

Swanson TW, Meneghetti AT, Sampath S, Connors JM, Panton ON. Hand-assisted laparoscopic splenectomy versus open splenectomy for massive splenomegaly: 20-year experience at a Canadian centre. Can J Surg. 2011;54(3):189-93.