Should Open Splenectomies Still Only be Recommended in Benign Heatologic Diseases Refractory to Medical Therapy?

Choi, Youn Baik; Min, Sang Jin; Ahn, Sang Hoon

Abstract

PURPOSE
A laparoscopic splenectomy (LS) has been proposed as a substitute to an open splenctomy (OS) in the treatment of benign hematological diseases that are refractory to medical therapy in many centers. However, in Korea, many clinicians do not inform patients of the option of a LS in whom a splenectomy is needed. This study was undertaken to compare the safety, the outcome including the clinical benefits of a LS and an OS for a variety of benign hematological diseases. METHODS: The records of 137 patients who underwent a splenectomy (15 OS and 122 LS) at the Asan Medical Center between January 1998 and December 2002 were reviewed retrospectively. The patient demographics, surgical indications, perioperative results, morbidity, mortality and clinical outcome were evaluated. RESULTS: Open splenectomies were performed by 4 surgeons and a LS was performed by one surgeon after receiving informed consent regarding each procedure (OS & LS). Thirty eight cases (28.2%) were transfered to our department from another hospital without being given any information of LS. There was no significant difference in age, gender, ASA grading, previous abdominal surgery and comorbid diseases between the two groups. The average operating time was longer in those given a LS than OS (P<0.05, 128 min. vs 98 min. respectively), but the volume of intraoperative blood loss was significantly lower for those receiving LS (P<0.05, 114+/-11.1 ml vs 201+/-10.1 ml, respectively). Five patients (4.1%) required a conversion to an open splenectomy during LS as a result of intraoperative bleeding (4 case) and severe adhesion (1 case). The mean postoperative analgesic (NSAID, Nonsteroidal Anti-inflammatory Drug) requirement was significantly smaller in those receiving a LS than an OS (P<0.05, 4.3 days vs 1.5 days, respectively). The length of the hospital stay was shorter in the LS group than in the OS group (P<0.05, 5.3+/-1.0 days vs 9.4+/-1.2 days, respectively) and there were significantly lower perioperative complications in the LS group than in the OS group (P<0.05, 11.5% vs 40%, respectively). There was no significant differences in the remission rate of ITP in those receiving a LS and OS (P>0.05, 84% vs 78%, respectively) during a mean follow-up period of 38+/-12 months. CONCLUSION: LS takes longer to perform but results in minimal blood loss, less analgesics, a shorter postoperative stay and fewer complications than OS. In addition, a laparoscopic splenctomy is a safe, efficacious and a superior treatment for patients with various benign hematological disorders. Therefore, it is strongly recommended that surgeons inform patients of the option of a LS and give consideration to a transfer to other hospitals where advanced laparoscopic procedures are feasible.