Clinical Research Analysis and Application Value of the Laparoscopic Retroperitoneal Approach in In Situ Splenectomy

The purpose of this study was to compare the effects of the laparoscopic posterior approach in in situ splenectomy with those of traditional splenectomy. The primary indications for splenectomy in our cohort were splenomegaly and hypersplenism secondary to liver cirrhosis and portal hypertension, which is a common clinical scenario in our hepatobiliary surgery-centred hospital.

A retrospective analysis was conducted on 58 patients who underwent splenectomy in our hospital. These were divided into 28 cases of laparoscopic posterior approach in situ splenectomy (posterior approach group) and 30 cases of traditional open splenectomy (open splenectomy group). Surgical indicators and postoperative complications were compared between the two groups.

Intraoperative blood loss, length of hospital stay and time to drainage clearance were substantially lower in the posterior approach group compared with the open splenectomy group. There was no significant difference in operation time. Postoperative complications in the posterior approach group included fever (7 cases), ascites (14 cases), pancreatic leakage (0 cases), rebleeding (1 case), secondary abdominal infection (0 cases) and venous thrombosis (2 cases). These were fewer than in the open splenectomy group, which presented with 18 cases of fever, 24 of ascites, 7 of pancreatic leakage, 4 of rebleeding, 3 of secondary abdominal infection and 6 of venous thrombosis. Statistically significant differences were observed in the incidence of pancreatic leakage, fever and ascites between the groups (p = 0.011, p = 0.007 and p = 0.016, respectively). No significant differences were found for rebleeding (p = 0.392), secondary abdominal infection (p = 0.238) or venous thrombosis (p = 0.299).

The laparoscopic retroperitoneal approach in in situ splenectomy demonstrates clear advantages over traditional splenectomy with respect to intraoperative performance and postoperative complications, offering improved safety and efficacy.