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

• Published in: World journal of surgery Vol. 45; no. 2; pp. 465 - 479
• Main Authors: Rodríguez-Luna, María Rita, Balagué, Carmen, Fernández-Ananín, Sonia, Vilallonga, Ramon, Targarona Soler, Eduardo María
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Blood; Cardiac Surgery; Clinical trials; Complications; Conversion; General Surgery; Laparoscopy; Medicine; Medicine & Public Health; Meta-analysis; Robotic surgery; Scientific Review; Splenectomy; Splenomegaly; Subgroups; Surgery; Systematic review; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05839-x

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.