Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis
Por:
Rodriguez-Luna, MR, Balague, C, Fernandez-Ananin, S, Vilallonga, R, Soler, EMT
Publicada:
1 feb 2021
Ahead of Print:
1 nov 2020
Resumen:
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.
Filiaciones:
Rodriguez-Luna, MR:
IRCAD, Res Inst Digest Canc, 1 Pl Hop, F-67000 Strasbourg, France
Autonomous Univ Barcelona UAB, Gastrointestinal & Hematol Surg Unit, Serv Gen & Digest Surg, Hosp Santa Creu & St Pau,Med Sch, Carrer St Antoni Ma Claret 167, Barcelona 08025, Spain
Balague, C:
Autonomous Univ Barcelona UAB, Gastrointestinal & Hematol Surg Unit, Serv Gen & Digest Surg, Hosp Santa Creu & St Pau,Med Sch, Carrer St Antoni Ma Claret 167, Barcelona 08025, Spain
Fernandez-Ananin, S:
Autonomous Univ Barcelona UAB, Gastrointestinal & Hematol Surg Unit, Serv Gen & Digest Surg, Hosp Santa Creu & St Pau,Med Sch, Carrer St Antoni Ma Claret 167, Barcelona 08025, Spain
Vilallonga, R:
Univ Autonoma Barcelona, Endocrine Metab & Bariatr Unit, Ctr Excellence EAC BC, Vall dHebron Univ Hosp, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Soler, EMT:
Autonomous Univ Barcelona UAB, Gastrointestinal & Hematol Surg Unit, Serv Gen & Digest Surg, Hosp Santa Creu & St Pau,Med Sch, Carrer St Antoni Ma Claret 167, Barcelona 08025, Spain
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