Laparoscopic vs open splenectomy in the management of hematologic diseases |
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Authors: | A Donini U Baccarani G Terrosu V Corno A Ermacora A Pasqualucci F Bresadola |
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Institution: | (1) Department of Surgery, University Hospital Udine Pad. Petracco P. le Santa Maria della Misericordia 33100 Udine, Italy, IT;(2) Division of Hematology, University Hospital Udine Pad. Petracco P. le Santa Maria della Misericordia 33100 Udine, Italy, IT;(3) Intensive Care Unit, University Hospital Udine Pad. Petracco P. le Santa Maria della Misericordia 33100 Udine, Italy, IT |
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Abstract: | Background: Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative
stay and more rapid return to full activity are the primary advantages of LS.
Methods: Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive
open splenectomies (OS) (group 2) were performed for hematologic diseases.
Results: The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started
to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and
age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach.
Conclusions: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach.
The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.
Received: 16 July 1998/Accepted: 20 January 1999 |
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Keywords: | : Accessory spleen — Hematologic malignancies — Hodgkin's disease — ITP — Laparoscopic surgery — Non-Hodgkin's disease — Splenectomy |
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