Anterior versus posterolateral approach for total laparoscopic splenectomy: a comparative study

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic splenectomy (LS) is a standard procedure for various splenic disorders.
• The anterior approach is commonly utilized for LS.
• The posterolateral approach may offer advantages in specific patient populations.

Purpose of the Study:

• To compare the effectiveness and safety of the posterolateral versus anterior approach for elective total LS.
• To evaluate outcomes in patients with non-severe splenomegaly.

Main Methods:

• Retrospective analysis of 203 patients undergoing elective LS between March 2005 and June 2011.
• Patients were divided into posterolateral and anterior approach groups.
• Key outcome measures included operation time, blood loss, pancreatic leakage, and hospital stay.

Main Results:

• The posterolateral approach (n=58) demonstrated significantly shorter operation times (65.0 ± 12.3 min vs. 95.0 ± 21.3 min) and reduced intraoperative blood loss (200.0 ± 23.4 mL vs. 350.0 ± 45.2 mL) compared to the anterior approach (n=145).
• Patients in the posterolateral group experienced a shorter hospital stay (5.0 ± 2.0 d vs. 9.0 ± 3.0 d).
• Pancreatic leakage rates were comparable, though slightly lower with the posterolateral approach (0.0% vs. 3.4%).

Conclusions:

• The posterolateral approach is a more effective and safer technique for laparoscopic splenectomy in patients without severe splenomegaly (< 30 cm).
• This approach offers significant benefits in terms of operative efficiency and patient recovery.