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

Moris, Demetrios; Dimitriou, Nikoletta; Grınıatsos, John

doi:10.21873/invivo.11058

Cited by 33 publications

(25 citation statements)

References 63 publications

(182 reference statements)

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“…Most (76%) patients are able to undergo laparoscopic surgery, irrespective of spleen size. This is consistent with recent findings that laparoscopic splenectomy has replaced open splenectomy as the criterion standard surgical intervention even in patients with massive splenomegaly [ 12 ].…”

Section: Discussionsupporting

confidence: 93%

Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes

Alobuia

Perrone

Iberri

et al. 2020

Surgery Open Science

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Background The role of splenectomy to diagnose and treat hematologic disease continues to evolve. In this single-center retrospective review, we describe modern morbidity, mortality, and long-term outcomes associated with splenectomy for benign and malignant hematologic disorders. Methods We analyzed all nontrauma splenectomies performed for benign or malignant hematologic disorders from January 2009 to September 2018. Variables collected included demographics, preexisting comorbidities, laboratory results, intra- and postoperative features, and long-term follow-up. Outcomes of interest included postoperative complications, 30-day mortality, and overall mortality. Results We identified 161 patients who underwent splenectomy for hematologic disorders. Median age was 54 years (range 19–94), and 83 (52%) were female. Splenectomy was performed for 95 (59%) patients with benign hematologic disorders and for 66 (41%) with malignant conditions. Most splenectomies were laparoscopic (76%), followed by laparoscopic hand assisted (11%), open (8%), and laparoscopic converted to open (6%). Median follow-up was 761 days (interquartile range: 179–2025 days). Major complications occurred in 21 (13%) patients. Three (2%) patients died within 30 days; 16 (9%) died more than 30 days after operation, none from surgical complications, with median time to death of 438 days (interquartile range: 231–1497 days). Among malignant cases, only preoperative thrombocytopenia predicted death (odds ratio = 5.8, 95% confidence interval = 1.1–31.8, P = .04). For benign cases, increasing age was associated with inferior survival (odds ratio = 2.3, 95% confidence interval = 1.0–5.1, P = .05). Conclusion Splenectomy remains an important diagnostic and therapeutic option for patients with benign and malignant hematologic disorders and can be performed with a low complication rate. Despite considerable burden of comorbid disease in these patients, early postoperative mortality was uncommon.

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Section: Discussionsupporting

confidence: 93%

Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes

Alobuia

Perrone

Iberri

et al. 2020

Surgery Open Science

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“…Machado et al found in their study that mean blood loss was 70 (range: 50–460) ml and operative time was 126 (range: 110–240) min [ 25 ]. In a systematic review Moris et al found that LS can be performed with minimal blood loss (30–60 ml), operative time was reported as 75–165 min, and the conversion rate to OS was in the range 0–4% [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count.

Zychowicz

Radkowiak

Lasek

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic splenectomy (LS) is the gold standard in treating immune thrombocytopenia (ITP). However, there are still some problems in decision-making when considering LS in patients with a very low platelet count (PLT).AimTo evaluate safety outcomes of LS in patients with severe ITP and very low PLT in comparison to those with higher PLT.Material and methodsWe retrospectively analyzed consecutive patients who underwent LS in a single institution between April 1998 and December 2017. Perioperative care was based on an algorithm developed at our department which takes into consideration the patient’s PLT level. Patients were divided into 2 groups depending on the PLT level (cut-off point 50,000/mm3).ResultsThe mean operative time in the low PLT group and high PLT group was 90 ±42.1 min and 95 ±45 min, respectively (p = 0.59). Intraoperative blood loss was 144 ±226.1 ml in the low PLT group and 83 ±161.24 ml in the high PLT group (p = 0.23). Complications occurred in 5 (9.09%) patients in the low PLT group and 16 (11.51%) in the high PLT group (p = 0.67). There were no conversions in the group with lower PLT, while 2 patients in the group with higher PLT had to be converted to open surgery (p = 0.38). Patients with low PLT preoperatively more often required perioperative platelet transfusions (13 vs. 1, p < 0.001).ConclusionsLaparoscopic splenectomy is safe and feasible treatment in patients with ITP regardless of the PLT level. Still, patients with critical ITP and marginally low PLT require special awareness.

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“…When patients fail medical therapy, they are referred for surgical removal of the spleen. 1 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.…”

Section: Introductionmentioning

confidence: 99%

“…5 However, the advantages of the laparoscopic over open splenectomy for hematological indications were not stated sufficiently and clinical trials to evaluate the role and efficacy of the approach are still mandatory. 1 LS via the anterior approach is the strategy done by most surgeons. This provides laparoscopic surgeons with a direct view of the spleen anatomy, as in conventional OS.…”

Section: Introductionmentioning

confidence: 99%

Splenectomy for haematological diseases: comparison between laparoscopic and open procedures

Gomaa

Khalil

2017

Int Surg J

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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.

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

Cited by 33 publications

References 63 publications

Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes

Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes

Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count.

Splenectomy for haematological diseases: comparison between laparoscopic and open procedures

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