Laparoscopic versus open Splenectomy in the management of hematological diseases

Document Type : Original Article

Authors

1 general surgery department zagzig university

2 Department of General Surgery, Zagazig University,Sharkia,Egypt

3 Department of general surgery- Faculty of Medicine- Zagazig University.

4 general surgery department, zagazig university

Abstract

Background: splenectomy traditionally was by open method, which required a big incision in the abdominal wall, long hospital stay and disfiguring scar. With time, the benefits of laparoscopic splenectomy (LS) over Open splenectomy (OS) included shorter hospital stay, quick return to work, and wound complications and better cosmetic results.
Methods: This is prospective randomized comparative study included patients when splenectomy is indicated due to hematological diseases who presented to Surgery Department of Zagazig University Hospitals during the period from September 2016 to May 2019.
Results: The mean age of patients was 22.17 ± 3.35, and 66.7% of them were female. .Pathology included 8 patients with (ITP), 5 thalassemia, 4 hereditary spherocytosis, 7 (AIHA). Mean operative time was 120.33± 23.14 minutes in the (LS) group vs 109.58 ± 18.12 min in the (OS) group. The (LS) group had a significantly shorter hospital stay compared to OS group (1.91± 0.79 day vs 3.83 ± 0.83 day). LS group was associated with less blood loss and blood transfusion during surgery, less complications and better outcome. Wound complication occur in 1 patient in the (LS) group vs 3 patient in the OS group.One patient in the (LS) group had intraoperative bleeding so, converted to open surgery due to difficult control.
Conclusions: Lap splenectomy is considered to be an emerging ‘gold standard’ procedure for all elective splenectomies in patients with hematological diseases. Rapid advances in technology, advanced laparoscopic instruments, endoscopic vascular stapler and ligasure aid the surgeons in removing even large spleens laparscopically.

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