Laparoscopic splenectomy versus open splenectomy: a comparative study

In 1993, we reported a new technique for laparoscopic splenectomy, namely the "hanging spleen" technique. The patient was placed in a right lateral supine position with the operator being located on the right of the patient. We herein report the results of 28 laparoscopic splenectomies performed with this technique until January 1996.

From 1993 to 1996, the results were compared with those of 28 patients operated on by open splenectomy from 1988 to 1995. The two groups were similar in terms of age, sex-ratio, and physical condition (ASA classification). Indications for splenectomy were the following in each group: idiopathic thrombocytopenic purpura (ITP) (n = 26 and 27, respectively) and hemolytic anemia (n = 2 and 1, respectively).

Accessory spleens were found in 3 patients of the laparoscopic group and in 5 patients of the open group. Three conversions to open procedure were necessary in the laparoscopic group, but two conversions might have been avoided. We have observed significant advantages in the laparoscopic approach: shorter ileus and postoperative stay. On the other hand, the procedure was longer than with open splenectomies. Three patients had postoperative complications in the laparoscopic group, whereas nine patients had complications in the open group. Recurrence of ITP was observed in 2 patients of the laparoscopic group and in 4 patients of the open group.

Our results suggest that laparoscopic splenectomy may be considered as a safe alternative to open splenectomy in patients with hematological diseases such as ITP and hemolytic anemia.