Our Summary

This study compares two methods of performing laparoscopic splenectomy (a minimally invasive procedure to remove the spleen): the anterior approach (from the front) and the lateral approach (from the side). The researchers looked at a variety of outcomes, including the need for blood transfusions, amount of blood lost during surgery, the need to switch to open surgery, recovery time, and length of hospital stay.

They found five studies that included a total of 728 patients. Their analysis showed that surgeries using the anterior approach were associated with a higher need for blood transfusions, more blood loss during surgery, a higher likelihood of needing to switch to open surgery, a longer recovery time, and a longer hospital stay compared to the lateral approach. However, there was no difference in mortality rate between the two methods.

The conclusion is that, based on the current evidence, the lateral approach seems to be better than the anterior approach for laparoscopic splenectomy. However, they note that the quality of the evidence is moderate and that more high-quality studies are needed to confirm these findings.

FAQs

  1. What were the two methods of laparoscopic splenectomy compared in this study?
  2. What outcomes did the study find were associated with the anterior approach to laparoscopic splenectomy?
  3. According to the study, is the lateral or anterior approach better for laparoscopic splenectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about splenectomy is to discuss with them the different approaches that can be taken during the procedure. Informed decision-making between the patient and their healthcare provider can help ensure the best possible outcome for the patient. It is important for patients to understand the potential risks and benefits of each approach in order to make the most appropriate choice for their individual situation.

Suitable For

Patients who may be recommended for splenectomy include those with:

  1. Hematologic disorders such as immune thrombocytopenic purpura (ITP), hereditary spherocytosis, and thalassemia.
  2. Traumatic injuries to the spleen.
  3. Splenic tumors or cysts.
  4. Autoimmune diseases such as systemic lupus erythematosus (SLE) or rheumatoid arthritis.
  5. Certain infections such as splenic abscess or recurrent infections in patients with sickle cell disease.
  6. Hypersplenism, where the spleen removes blood cells prematurely, leading to low blood cell counts.

Timeline

Before splenectomy:

  1. Patient undergoes diagnostic tests such as blood tests, imaging studies, and possibly a biopsy to confirm the need for splenectomy.
  2. Patient is informed about the procedure, risks, benefits, and alternatives.
  3. Patient may need to undergo preoperative preparation such as stopping certain medications and fasting before surgery.

After splenectomy:

  1. Patient undergoes laparoscopic splenectomy, either through the anterior or lateral approach.
  2. Patient may require blood transfusions during or after surgery depending on the amount of blood lost.
  3. Recovery time varies but may be longer with the anterior approach compared to the lateral approach.
  4. Patient may experience pain, fatigue, and limited activity in the immediate postoperative period.
  5. Patient is monitored for complications such as infection, bleeding, or blood clots.
  6. Patient may need vaccinations and antibiotics to prevent infections due to the absence of the spleen.
  7. Patient may experience changes in immune function and increased risk of certain infections in the long term.
  8. Patient may need regular follow-up visits with healthcare providers to monitor for complications and manage any long-term effects of splenectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about splenectomy include:

  1. What are the reasons for recommending a splenectomy in my case?
  2. What are the potential risks and complications associated with the surgery?
  3. What are the expected outcomes and recovery time after the procedure?
  4. Will I need a blood transfusion during or after the surgery?
  5. What is the difference between the anterior and lateral approach for laparoscopic splenectomy?
  6. Why is one approach recommended over the other in my case?
  7. How many of these procedures have you performed, and what is your success rate?
  8. Will I need any additional treatments or medications after the surgery?
  9. What long-term effects should I expect after having my spleen removed?
  10. Are there any lifestyle changes I should consider following the procedure?

Reference

Authors: Rehman S, Hajibandeh S, Hajibandeh S. Journal: Surg Laparosc Endosc Percutan Tech. 2019 Aug;29(4):233-241. doi: 10.1097/SLE.0000000000000627. PMID: 30629037