Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis
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SCIENTIFIC REVIEW
Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis Marı´a Rita Rodrı´guez-Luna1,2 • Carmen Balague´2 • Sonia Ferna´ndez-Ananı´n2 • Ramon Vilallonga3 • Eduardo Marı´a Targarona Soler2
Accepted: 11 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
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.
& Eduardo Marı´a Targarona Soler [email protected] 1
IRCAD, Research Institute against Digestive Cancer, France 1 Place de l’Hoˆpital, 67000 Strasbourg, France
2
Gastrointestinal and Hematological Surgical Unit, Service of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona (UAB) Medical School, Carrer Sant Antoni Ma Claret, 167, 08025 Barcelona, Spain
3
Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d’Hebron University Hospital, Universitat Auto`noma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
Introduction The laparoscopic approach is considered the gold standard surgical technique for diseases requiring removal of the spleen [1, 2]. Since the first laparoscopic splenectomy (LS) was performed by Delaitre et al. [3] in 1991, laparoscopy has proven to be especially useful for surgical treatment of diseases associated with a normal-sized or slightly en
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