Laparoscopic vs open splenectomy in the management of hematologic diseases.
BACKGROUND
Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative stay and more rapid return to full activity are the primary advantages of LS.


METHODS
Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive open splenectomies (OS) (group 2) were performed for hematologic diseases.


RESULTS
The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach.


CONCLUSIONS
Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach. The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.
Donini
A
A
Department of Surgery, University Hospital Udine Pad. Petracco P. le Santa Maria della Misericordia 33100 Udine, Italy.
Baccarani
U
U
Terrosu
G
G
Corno
V
V
Ermacora
A
A
Pasqualucci
A
A
Bresadola
F
F
D000293:Adolescent; D000328:Adult; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods*