Laparoscopic splenectomy. The initial experience at University of California, San Francisco
L. F. Yee, S. H. Carvajal, A. A. de Lorimier and S. J. Mulvihill
Department of Surgery, University of California, San Francisco, USA.
OBJECTIVE: To evaluate the outcomes of patients undergoing laparoscopic
splenectomy (LS) at a single institution. DESIGN: Case control. SETTING:
University teaching hospital. PATIENTS: The medical records of the initial
25 consecutive patients who underwent LS at a single institution were
reviewed. For comparison, a control group of 25 patients undergoing open
splenectomy (OS) matched for age, diagnosis, and splenic weight were also
reviewed. MAIN OUTCOME MEASURES: Data regarding operative time, blood loss,
pathologic findings, complications, postoperative hospital stay, ileus
duration, preoperative and postoperative hematocrit and platelet counts,
blood and platelet transfusions, and hospital costs were collected.
RESULTS: Twenty-five patients underwent attempted LS. Four procedures (16%)
were converted to OS. Operative time averaged 3.3 +/- 0.2 hours for LS and
2.6 +/- 0.1 hours for OS (P = .001). In the LS group, a regular diet was
tolerated 2.1 +/- 0.3 days after surgery (P < .001), and mean
postoperative hospital stay was 5.1 +/- 0.6 days (P = .037), compared with
4.3 +/- 0.3 and 6.7 +/- 0.5 days, respectively, in the OS group. No
differences were observed in blood loss, complication rate, transfusion
requirement, or hospital cost. CONCLUSIONS: Compared with OS, LS requires
more operative time, is comparable in blood loss, transfusion requirement,
complication rate, and cost, and appears to be superior in terms of return
of bowel function and hospital stay.
