Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

Abstract

Background The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). Methods We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. Results Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient-and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p \ 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p \ 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. Conclusions Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.Keywords Clinical paper Á Trials Á Splenic artery aneurysms Recent literature reports on the feasibility, safety, and effectiveness of laparoscopic management of splenic artery aneurysms (SAA) as well as its appreciation by patientsoften young females-who harbour the disease [1][2][3][4][5][6][7][8][9][10][11][12][13]. Thus, laparoscopy may represent an interesting alternative to open surgery and provided that the same range of technical solutions offered by open surgery can be achieved with similar results [1,[14][15][16][17][18] and the general advantages of laparoscopy are confirmed in this specific application, the laparoscopic option may represent a challenging alternative not only to laparotomic surgery but also to endovascular procedures. Endovascular management, albeit minimally invasive, requires accurate patient selection and presents some Registration Number: NCT01387828.

Laparoscopic approach to splenic aneurysms

“…It was statistically different from laparoscopic approach 125 ± 34 min. 33 In our department, the duration of surgery (mean 122 ± 55 min) was not significantly different from Tiberio’s results. Mean blood loss in our department was 36 ± 36 ml, which was significantly lower than that reported in literature.…”

“…First randomised controlled trial comparing open with laparoscopic approach was performed by Tiberio et al. 33 Mean time of open surgery was 190 ± 48 min. It was statistically different from laparoscopic approach 125 ± 34 min.…”

Vascular Diseases of the Spleen: A Review

“…In a prospective study conducted by Tiberio et al 52 involving 29 SAA patients who were randomized to either laparoscopy or laparotomy, the laparoscopy group had lower morbidity rates, shorter hospital stays and more rapid recoveries. The 13.3% conversion rate from laparoscopic to open surgery was due to concomitant involvement of the pancreatic tail, and iatrogenic vessel tear during dissection 52.…”

“…The 13.3% conversion rate from laparoscopic to open surgery was due to concomitant involvement of the pancreatic tail, and iatrogenic vessel tear during dissection 52. Although, it was reported that laparoscopic repair cannot be done in cases of an SAA rupture, Kim et al 53 was able to successfully repair a ruptured SAA laparoscopically.…”

Laparoskopisches Ausschalten eines Aneurysmas der A. lienalis

“…Letztere Autoren führten jedoch eine laparoskopische Splenektomie zur Behandlung des Aneurysmas durch, wie dies auch andere Kasuistiken berichten [12]. Prospektiv randomisiert haben Tiberio et al 14 [13].…”