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01-02-2021 | Splenectomy | Scientific Review

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

Authors: María Rita Rodríguez-Luna, Carmen Balagué, Sonia Fernández-Ananín, Ramon Vilallonga, Eduardo María Targarona Soler

Published in: World Journal of Surgery | Issue 2/2021

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.

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Title: Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis
Authors: María Rita Rodríguez-Luna
Carmen Balagué
Sonia Fernández-Ananín
Ramon Vilallonga
Eduardo María Targarona Soler
Publication date: 01-02-2021
Publisher: Springer International Publishing
Keywords: Splenectomy
Splenectomy
Published in: World Journal of Surgery / Issue 2/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05839-x

At a glance: The STEP trials

Springer Medicine

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

Abstract

Objectives

Background

Review methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Background

Review methods

Results

Conclusion

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