Anterior Versus Posterolateral Approach for Total Laparoscopic Splenectomy: A Comparative Study

Abstract

Objective: Although the anterior approach is normally used for elective laparoscopic splenectomy (LS), the posterolateral approach may be superior. We have retrospectively compared the effectiveness and safety of these approaches in patients with non-severe splenomegaly scheduled for elective total LS.Methods: Patients with surgical spleen disorders scheduled for elective LS between March 2005 and June 2011 underwent laparoscopic splenic mobilization via the posterolateral or anterior approach. Main outcome measures included operation time, intraoperative blood loss, frequency of postoperative pancreatic leakage, and length of hospital stay.Results: During the study period, 203 patients underwent LS, 58 (28.6%) via the posterolateral and 145 (71.4%) via the anterior approach. Three patients (1.5%) required conversion to laparotomy due to extensive perisplenic adhesions. The posterolateral approach was associated with significantly shorter operation time (65.0 ± 12.3 min vs. 95.0 ± 21.3 min, P < 0.01), reduced intraoperative blood loss (200.0 ± 23.4 mL vs. 350.0 ± 45.2 mL, P < 0.01), and shorter hospital stay (5.0 ± 2.0 d vs. 9.0 ± 3.0 d, P < 0.01) than the anterior approach. The frequency of pancreatic leakage was slightly lower in patients undergoing LS via the posterolateral than the anterior approach (0.0% vs. 3.4%, P > 0.05)Conclusions: The posterolateral approach is more effective and safer than the anterior approach in patients without severe splenomegaly (< 30 cm).

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

“…There are three postures commonly used in LSD: right lateral position, right oblique position and lithotomy position [15,16] . Right lateral position is superior to right oblique position in dissociation of splenic ligaments, but inferior in processing the splenic pedicle and devascularization.…”

Safe approach to the splenic hilum by first mobilizing the pancreatic tail in laparoscopic splenectomy

“…In terms of bleeding control, mobilizing the spleen after interrupting whole blood flow is reasonable because this avoids injuring the spleen capsule. Because we routinely clip the splenic artery at the superior border of the pancreatic body or tail before dissecting the splenic hilum to reduce bleeding , bleeding can be controlled easily by elevating the tape, even if the splenic vein is injured in the splenic hilum. After the splenic artery has been clipped, the pancreatic tail's blood flow is supplied through the intrapancreatic communicating branches .…”

“…Most of the disorders that require splenectomy are benign diseases; therefore, laparoscopic surgery has great benefit for patients with such disorders because of its minimal invasiveness . In splenectomy, it is extremely important to prevent bleeding from the splenic hilum and the splenic capsule and to prevent the formation of postoperative pancreatic fistula through the safe division of the splenic hilum .…”

Aspectos anatómicos y técnicos de la cirugia de citorredución de cáncer de ovario en abdomen superior

“…La técnica quirúrgica puede realizarse a través de una abordaje anterior a través del ligamento gastroesplénico o posterolateralmente, a través del ligamento esplenorenal. 43,44 El abordaje puede ser por vía abierta o laparoscópica, siendo la ejecución de la técnica la misma en ambos tipos de cirugía. 43 En la selección de la técnica se deben considerar diversos factores, tales como el tamaño del bazo, la extensión de la enfermedad y la ubicación en cuanto a los cuadrantes.…”