Hand-assisted laparoscopic splenectomy versus open splenectomy for massive splenomegaly: 20-year experience at a Canadian centre

Abstract

Background: Multiple techniques for splenectomy are now employed and include open, laparoscopic and hand-assisted laparoscopic splenectomy (HALS). Concerns regarding a purely laparoscopic splenectomy for massive splenomegaly (> 20 cm) arise from potentially longer operative times, higher conversion rates and increased blood loss. The HALS technique offers the potential advantages of laparoscopy, with the added safety of having the surgeon's hand in the abdomen during the operation. In this study, we compared the HALS technique to standard open splenectomy for the management of massive splenomegaly. Methods:We reviewed all splenectomies performed at 5 hospitals in the greater Vancouver area between 1988 and 2007 for multiple demographic and outcome measures. Open splenectomies were compared with HALS procedures for spleens larger than 20 cm. Splenectomy reports without data on spleen size were excluded from the analysis. We performed Student t tests and Pearson χ 2 statistical analyses.Results: A total of 217 splenectomies were analyzed. Of these, 39 splenectomies were performed for spleens larger than 20 cm. We compared the open splenectomy group (19 patients) with the HALS group (20 patients). There was a 5% conversion rate in the HALS group.

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

“…Ιf LS is chosen, it can be performed using the same surgical technique, providing that the ports are placed more caudally on the abdominal wall, directly related to the lower pole of the spleen (30). For these patients, hand-assisted LS has been proposed (11,20,31,32) as an effective, safe and feasible alternative. Analyzing the feasibility of LS in cases of massive splenomegaly (spleen weight >2000 g) in patients with benign hematological disorder, Al-Mulhim (7) concluded that although LS was feasible in 90% of patients, the condition was significantly associated with prolonged operative time, more blood loss, increased postoperative morbidity, longer time to liquid diet and prolonged postoperative hospital stay.…”

Minimally invasive splenectomy: an update and review

“…There has been debate over whether imaging for accessory spleens is necessary. 11,16,22,25 However, the sensitivity and specificity of computed tomography (CT) for detecting accessory spleens is 60% and 95.6%, respectively, whereas that of laparoscopic detection is 93.3% and 100%, respectively. Perioperative CT for the detection and localization of accessory spleens may not be necessary.…”

Splenectomy for haematological diseases: comparison between laparoscopic and open procedures

“…14 However, this was higher than that seen by Swanson et al who found only a 5% incidence of conversion to open laparoscopy. 17 Hospital stay after operation in the LS group showed a mean of around 3 days; which is much less than those recorded in the OS group (9 days). The study of Ardestani et al showed that the median hospital stay among laparoscopic splenectomy was much lower (3 days) than open splenectomy (5 days).…”