Laparoscopic Splenectomy: Is This the Way to Do It?

Abstract

The literature since 1991 was reviewed in an attempt to answer the question as to the presumptive superiority of laparoscopic splenectomy to open splenectomy. Most pediatric series are small. No randomized study has been published at present, and most studies are retrospective. Except for a few studies in adults dealing entirely with idiopathic thrombocytopenia purpura, the studies are heterogeneous regarding the indication for splenectomy. Moreover, most publications deal with feasibility and safety only, and initial experience is not separated from later experience. There is a high incidence of residual splenic tissue after laparoscopic splenectomy. The reduced portal venous flow related to the pneumoperitoneum may predispose to portal venous thrombosis. Large spleens are difficult to remove laparoscopically. Initial ligation or embolization of the splenic artery in such cases has been proposed. Open surgery has evolved as well and uses much smaller incisions than before. There is little doubt that such an approach also diminishes invasiveness. There is more or less a consensus in the laparoscopic surgical world that laparoscopic splenectomy takes longer and is more expensive in terms of operating room costs. However, the overall complication rate is lower, analgesic requirement is lower, gastrointestinal function resumes earlier, and hospital stay is shorter, making laparoscopic splenectomy perhaps equally expensive. Cosmesis is certainly better after laparoscopic removal of the spleen, but hard evidence for overall superiority of laparoscopic splenectomy is lacking at present.