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Laparoscopic Versus Open Splenectomy for Nontraumatic Diseases

Maurus, Christine ; Schäfer, Markus ; Müller, Markus ; Clavien, Pierre-Alain ; Weber, Markus

In: World Journal of Surgery, 2008, vol. 32, no. 11, p. 2444-2449

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    Titre
    • Laparoscopic Versus Open Splenectomy for Nontraumatic Diseases
    Auteur
    • Maurus, Christine. Department of Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
    • Schäfer, Markus. Department of Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
    • Müller, Markus. Department of Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
    • Clavien, Pierre-Alain. Department of Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
    • Weber, Markus. Department of Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • World Journal of Surgery, 2008, vol. 32, no. 11, p. 2444-2449. Springer-Verlag
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:318352
    Summary
    Background: Laparoscopic splenectomy (LS) is the standard procedure for normal size or moderately enlarged spleens; open splenectomy (OS) is preferred in cases of splenomegaly. In this study, indications for and complications of open and laparoscopic splenectomy were analyzed, with the aim to identify patients who will benefit from either technique. Method: A consecutive series of 52 patients undergoing elective open or laparoscopic splenectomy between January 2001 and December 2006 was analyzed. Spleen volume was calculated as length×width×depth from the pathologist's measurements. Results: LS was performed in 25 patients with a median age of 41years (range=24-65). OS was performed in 27 patients with a median age of 60years (range=24-86) (p<0.001). Conversion to OS was necessary in two patients (8%). Operation time was significantly shorter in LS (p<0.05). Spleen volume was significantly greater in patients who underwent open (median=2520ml, range=150-16,800ml) versus laparoscopic (median=648ml, range=150-4860ml) splenectomy (p=0.001). In 36% of all laparoscopic procedures, spleen volume exceeded 1000ml. The underlying disease was mainly immunothrombocytopenia in LS patients and lymphoma and osteomyelofibrosis in OS patients. Five patients died after OS. Significantly more patients were hospitalized longer than 7days following OS than following LS (p<0.05). Overall complication rate was higher after OS (LS, 8; OS, 13 patients; p<0.05). Conclusions: LS was preferred in younger patients with moderate splenomegaly, while massive splenomegaly mostly led to OS. In view of the absence of technique-related differences, LS can primarily be attempted in all patients