LAPAROSCOPIC SPLENECTOMY BY THE LATERAL APPROACH - A SAFE AND EFFECTIVE ALTERNATIVE TO OPEN SPLENECTOMY FOR HEMATOLOGIC DISEASES

Background. The purpose of this study was to compare the clinical outc omes and expense of laparoscopic splenectomy by the lateral approach w ith open splenectomy for the treatment of hematologic diseases. Method s. Medical records of 20 matched patients undergoing open splenectomy and lateral approach laparoscopic splenectomy were retrospectively rev iewed detailing perioperative course, clinical outcome, and hospital c harges. Results. Patients undergoing laparoscopic splenectomy (n = 10) experienced longer anesthesia (324 versus 176 minutes; p < 0.05) and operative times (261 versus 131 minutes; p < 0.05) than those undergoi ng open splenectomy (n = 10). No difference was noted in both intraope rative and postoperative packed red blood cells transfused. Laparoscop ic splenectomy resulted in a shorter duration of nasogastric decompres sion (1.2 versus 2.6 days), more rapid resumption of normal oral intak e (1.9 versus 4.4 days), and earlier hospital dismissal (3.0 versus 5. 8 days). Although hospital charges were not significantly higher in th e laparoscopic group ($17,071.00 versus $13,196.00; P > 0.05), operati ve charges were always significantly higher Conclusions. When compared with open splenectomy, lateral approach laparoscopic splenectomy allo ws a more rapid return of normal gastrointestinal function and shorter hospital stay. The operative expense of laparoscopic splenectomy is s ignificantly higher; however, the overall hospital expense is not. If costs can be decreased, the lateral approach laparoscopic splenectomy will be the preferred operative approach.