Our Summary

This research paper looks at a procedure called laparoscopic partial splenectomy (LPS), which is a type of surgery on the spleen. The study reviewed other research papers from 1995 to 2018 to see if LPS is safe, possible, and beneficial.

The researchers found 44 studies involving 252 patients who had the LPS procedure. Some of these patients had other operations at the same time. The time to perform the surgery and the amount of blood lost varied widely. Only eight patients needed a blood transfusion, and the procedure had to be changed in only 3.6% of cases. About 11% of patients developed complications either during or after the surgery, but nobody died as a result of the surgery. The time patients stayed in the hospital after the surgery varied from 1 to 11 days.

The researchers also compared LPS with other types of spleen surgery. One study showed that LPS could mean a shorter hospital stay and fewer complications than a total spleen removal. Another study suggested LPS could be beneficial for emergency patients. However, one study found that children with a specific disease had more pain, took longer to start eating and drinking after surgery, and stayed in hospital longer after LPS. Another study found that a different type of spleen surgery using a robot was about the same as LPS in terms of hospital stay and complications, but had benefits like less blood loss.

In conclusion, the researchers found that LPS can be safe and possible in carefully chosen patients, as long as the surgeon is experienced in the procedure.

FAQs

  1. What were the main findings of the review on laparoscopic partial splenectomy (LPS)?
  2. How does laparoscopic partial splenectomy (LPS) compare to laparoscopic total splenectomy (LTS) in terms of postoperative stay and complications?
  3. What were the main benefits of robotic subtotal splenectomy compared to traditional laparoscopy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about splenectomy is to follow post-operative care instructions carefully, including avoiding heavy lifting and strenuous activity for a certain period of time to allow the spleen remnant to heal properly. It is also important to watch for signs of infection, such as fever or increased pain, and to follow up with the surgeon for regular check-ups to ensure a smooth recovery.

Suitable For

Patients who may be recommended for splenectomy include those with conditions such as hereditary spherocytosis, immune thrombocytopenic purpura (ITP), thalassemia, splenic trauma, and certain types of cancer such as lymphoma. It is important to note that splenectomy is typically considered a last resort treatment option and is only recommended when other treatment options have been unsuccessful or deemed inappropriate for the patient’s specific condition. Additionally, patients who are undergoing splenectomy should be carefully evaluated by a multidisciplinary team of healthcare providers to ensure that they are appropriate candidates for the procedure and to minimize the risk of complications.

Timeline

Before splenectomy:

  • Patient presents with a condition that may require splenectomy, such as hereditary spherocytosis or splenic trauma.
  • Patient undergoes preoperative evaluation and imaging studies to assess the need for splenectomy.
  • Surgical team discusses the risks and benefits of splenectomy with the patient.
  • Surgery is scheduled and patient undergoes preoperative preparation.

After splenectomy:

  • Laparoscopic partial splenectomy (LPS) is performed, with ranges of operative time and estimated blood loss varying.
  • Some patients may require blood transfusion during or after the surgery.
  • Postoperative complications may occur in some patients, with an overall complication rate of 10.7%.
  • The length of postoperative stay varies among patients, with some studies showing that LPS may reduce postoperative stay compared to laparoscopic total splenectomy.
  • Some comparative studies show that LPS may benefit emergency patients, but may be associated with more pain and longer recovery time in children with hereditary spherocytosis.
  • Overall, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons, with potential benefits such as lower blood loss and better evaluation of splenic remnant volume.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a splenectomy?
  2. How will my immune system be affected by the removal of my spleen?
  3. Will I need to take any special precautions or medications after the surgery?
  4. How long is the recovery process expected to be?
  5. Are there any alternative treatment options to consider before proceeding with a splenectomy?
  6. Will I need any additional vaccinations or preventive measures to protect against infections after the surgery?
  7. How will my quality of life be impacted after a splenectomy?
  8. Are there any long-term effects or complications I should be aware of?
  9. What is the likelihood of needing a blood transfusion during or after the surgery?
  10. How experienced are you in performing laparoscopic partial splenectomies, and what is your success rate with this procedure?

Reference

Authors: Liu G, Fan Y. Journal: World J Surg. 2019 Jun;43(6):1505-1518. doi: 10.1007/s00268-019-04946-8. PMID: 30767061