Does Laparoscopic Splenectomy have the Advantage on Postoperative Pain?

PURPOSE: The aim of this study is to elucidate the fundamental characteristics of the laparoscopic splenectomy and to compare the clinical outcomes and postoperative pain between the laparoscopic splenectomy and the conventional open splenectomy. METHODS: From January 2005 to January 2013, 28 patients underwent a splenectomy at Pusan National University Hospital, South Korea (PNUH). This study was a comparison of the demographic features and clinical results between the laparoscopic splenectomy (n=15) and open splenectomy (n=13). RESULTS: For the two groups of patients, the following were similar: estimated blood loss, transfusion, operative time, duration of patient-controlled analgesia, and the additional administration of painkillers. In the laparoscopic splenectomy group, the postoperative hospital stay (7.9+/-1.6 days versus 5.9+/-1.4 days, p=0.002) and the diet start time (2.7+/-0.3 days versus 1.8+/-0.8 days, p=0.003) were significantly shorter. No significant difference in postoperative pain was observed between the two groups. CONCLUSION: In this study, there was no benefit for postoperative pain in the LS group. However, the laparoscopic splenectomy has several benefits, including a shorter postoperative hospital stay and an earlier diet start time; in addition, it is feasible and safe.

Treatment Result of Laparoscopic Versus Open Splenectomy in Benign Splenic Diseases

PURPOSE: The purpose of this study was to compare the clinical outcomes between laparoscopic (LS) and conventional open splenectomies (OS) in benign splenic diseases. METHODS: We retrospectively reviewed the medical records of patients who had undergone a splenectomy between June 1991 and April 2004. The patients' demographics and operative outcomes were also evaluated. RESULTS: Fifty-four patients were identified; LS and OS were performed in 41 and 13 patients, respectively. The age, gender and operative times between the two groups were similar. The time to resumption of oral intake was faster in the LS patients (2.0 +/- 0.9 vs. 4.0 +/- 5.1 days; P<0.0001). The length of hospital stay was shorter in the LS patients (4.0 +/- 2.4 vs. 12.0 +/- 7.4 days; P<0.0001). There were also significantly lower perioperative complications in the LS compared to the OS patients (4.8 vs. 38.5%; P=0.0017). In the patients with idiopathic thrombocytopenic purpura (ITP), there were no differences in the detection rate of an accessory spleens and the treatment response between the two groups. CONCLUSION: This study shows that LS is a safer than OS, and is an excellent surgical method: earlier diet tolerance, shorter hospital stay and fewer perioperative complications, with good cosmesis. Also, there was no difference in the surgical responses to treatment between the two procedures. Therefore, LS can become the gold standard for the treatment of benign diseases of the spleen.

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

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 (P0.05, 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.