Laparoscopic splenectomy: clip ligation or en-bloc stapling?

Various techniques are used in the management of splenic hilum during laparoscopic splenectomy. Among them, the most used ones are polymer clips, en-bloc stapling and ultrasonic devices. To the best of our knowledge, there is no study in the literature comparing the results of clip and stapler techniques. This study was aimed to compare our results of clip ligation and en-bloc stapling of the splenic hilum.

The records of 67 patients undergoing laparoscopic splenectomy between December 2012 and October 2017 were reviewed. Patients were divided into two groups according to surgical method (stapler group: 26 patients and clip group: 41 patients). Patient age, sex, diagnosis, surgical technique, operation time, spleen dimensions, perioperative complications, postoperative hospital stay, blood transfusions, postoperative thrombocyte and hemoglobin levels were recorded.

Operating time was median 115 min (75-230) in the stapler group and 120 min (60-210) in the clip group, and there was no significant difference between the groups (p= 0.2593). There were no significant difference between the groups in terms of the postoperative complications (p= 0.59). Postop- erative hospital stay was median 3.5 (2-8) days in the stapler group and 3 (2-6) days in the clip group with no significant difference (p= 0.0733).

Clip ligation and en-bloc stapling techniques have no superiority over each other. Our results also showed that both techniques are safe and feasible. We suggest opting for the method according to the surgeon's experience and hospital facilities.