Laparoscopic splenectomy: an evolving technique. A comparison between anterior and lateral approaches.
BACKGROUND
The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Laparoscopic splenectomy (LS) suffers from several technical problems for mobilization and manipulation of a solid organ. Lateral approach has been proposed as an alternative to the anterior approach which facilitates LS. The aim of this paper is to compare the results of LS using and anterior or lateral approach.


METHODS
Between February 1993 and May 1995, 27 LS were performed (group I, Ant-LS, n: 10; group II, Lat-SL, n: 17). LS was indicated in 19 patients for treatment of an idiopathic purpura, for spherocytosis in four; for AIDS-related thrombocytopenia in two; and for autoimmune anemia and leucopenia in two. Gallstones were associated in two cases and an ovarian cyst in another.


RESULTS
LS was completed in 8 patients of group I (80%) and 17 of group II (100%). Operative time (236 +/- 21 min vs 159 +/- 71 min p < 0.003), number of trocars (4.5 +/- 0.5 vs 4 +/- 0.5, p < 0.02), transfusion requirements (60 vs 17%, p < 0.04) and mean stay (6.5 +/- 3.6 days vs 4 +/- 2 days, p < 0.05) were significantly lower in the group of LS with a lateral approach.


CONCLUSIONS
The lateral approach significantly facilitates the performance of LS compared with the anterior approach.
Trias
M
M
Service of General and Digestive Surgery, University of Barcelona, Spain.
Targarona
E M
EM
Balagué
C
C
D000328:Adult; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*