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  • Title: 20 years' experience with laparoscopic splenectomy. Single center outcomes of a cohort study of 500 cases.
    Author: Radkowiak D, Zychowicz A, Lasek A, Wysocki M, Major P, Pędziwiatr M, Budzyński P, Kulawik J, Budzyński A.
    Journal: Int J Surg; 2018 Apr; 52():285-292. PubMed ID: 29481990.
    Abstract:
    BACKGROUND: Laparoscopic splenectomy (LS) has become the gold standard in elective spleen surgery. Although it is considered relatively safe, treatment results vary depending on a hospital's profile and the experience of the surgeon and center. We would like to present experience of a high-volume referral center with minimally invasive operations of the spleen. MATERIAL AND METHODS: The retrospective cohort study included consecutive patients undergoing laparoscopic splenectomy in tertiary referral surgical center in 1998-2017. The entire study population (500 patients) was grouped into 5 cohorts of 100 consecutively operated patients. The primary endpoints were short-term outcomes of LS and secondary - analysis of indications and operative technique. The study group consisted of 316 women and 184 men, 46 (28-59) years old on average. RESULTS: The most common indications for splenectomy were ITP (53%), lymphoma (21%) and spherocytosis (7%). Ratio of ITP versus other indications decreased significantly over time in favor of more difficult cases (<0.001). Average operative time of 100 (75-132.5) min and blood loss of 50 (20-150) ml were changing during study. Forty two patients required a blood transfusion with no difference among groups (p = 0.765). The use of postoperative drainage diminished from 100% to 7% (p < 0.001). The overall conversion rate (3%) and intraoperative complications (5%) did not differ among groups (p = 0.863 and 0.888). Perioperative morbidity was 8.6% and decreased significantly over time (OR: 0.78, 95%CI: 0.62-0.98). We noted mortality of 0.4% (1 patient in 1st and 1 in 5th group). Median LOS was 4 (1-16) days. A significant change in the operative technique from vessels first to hilar transection was noted. CONCLUSION: Laparoscopic splenectomy seems to be a safe method associated with a low risk of perioperative complications and mortality. A careful reproducible operative technique, along with a well-trained team and standardized modern postoperative care is critical to improving outcomes.
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