Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

Abstract

Objectives To review the evidence regarding the outcomes of laparoscopic techniques in cases of splenomegaly. Background Endoscopic approaches such as laparoscopic, hand-assisted laparoscopic, and robotic surgery are commonly used for splenectomy, but the advantages in cases of splenomegaly are controversial. Review methods We conducted a systematic review using PRISMA guidelines. PubMed/MEDLINE, ScienceDirect, Scopus, Cochrane Library, and Web of Science were searched up to February 2020. Results Nineteen studies were included for meta-analysis. In relation to laparoscopic splenectomy (LS) versus open splenectomy (OS), 12 studies revealed a significant reduction in length of hospital stay (LOS) of 3.3 days (p = \0.01) in the LS subgroup. Operative time was higher by 44.4 min (p \ 0.01) in the LS group. Blood loss was higher in OS 146.2 cc (p = \0.01). No differences were found regarding morbimortality. The global conversion rate was 19.56%. Five studies compared LS and hand-assisted laparosocpic splenectomy (HALS), but no differences were observed in LOS, blood loss, or complications. HALS had a significantly reduced conversion rate (p \ 0.01). In two studies that compared HALS and OS (n = 66), HALS showed a decrease in LOS of 4.5 days (p \ 0.01) and increase of 44 min in operative time (p \ 0.01), while OS had a significantly higher blood loss of 448 cc (p = 0.01). No differences were found in the complication rate. Conclusion LS is a safe approach for splenomegaly, with clear clinical benefits. HALS has a lower conversion rate. Higher-quality confirmatory trials with standardized splenomegaly grading are needed before definitive recommendations can be provided. Prospero registration number: CRD42019125251.

Partial splenectomy after preoperative embolization in a patient with metastatic melanoma – A case report

“…However, the procedures have not been compared in a RCT. Laparoscopic splenectomy is associated with longer operation time, but lower surgical mortality (0.2% vs 1%), shorter hospital stay and less perioperative blood loss, thus being the standard approach in many departments [10] , [11] . PS is on the other hand in >80% of the cases done by laparotomy, but since 1995 and 2010 laparoscopic and robotic PS, respectively, are being conducted [4] .…”

Laparoscopic splenectomy and esophagogastric devascularization combined with fast-track principles offers greater benefit for patients with portal hypertension.

“…SED can not only reduce the high risk of variceal bleeding but also lessen the adverse effects of splenomegaly and hypersplenism. LSED has obvious advantages over SED in terms of less trauma and faster recovery [ 16 – 18 ]. Therefore, LSED is an important treatment for patients with a high risk of variceal hemorrhage in our department.…”

Esplenectomía Laparoscópica en Esplenomagalia Masiva Por Linfoma No Hodgkin De Zona Marginal.

“…La esplenectomía laparoscópica en esplenomegalias masivas o supramasivas constituye un desafío técnico, aunque es factible su realización en forma segura y con buenos resultados según lo demostrado por Grahn (4) , Casaccia (5) , Tsamalaidza (6) y Rodríguez-Luna (8) .…”

“…A modo de síntesis Rodríguez-Luna (8) en un metaanálisis publicado en 2021 que incluyó 20 trabajos que comparan las esplenectomías laparoscópicas exclusivas, mano asistidas y abiertas en esplenomegalias masivas concluyó que la esplenectomía laparoscópica es factible y segura.…”