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 m ore rapid return to full activity are the primary advantages of LS. Methods: Prospective data collection of 44 consecutive LS (group 1) and com parison with a historical control group of 56 consecutive open splenectomie s (OS) (group 2) were performed for hematologic diseases. Results: The LS patients started earlier on an oral diet (p < 0.0001) and l eft the hospital sooner (p < 0.0002) than OS patients. Less blood transfusi on (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 d iagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started to eat earlier (p < 0.0001) and left the hospita l sooner (p < 0.01), Multivariate analysis showed that time to oral diet an d postoperative stay was related to operative technique and age. Morbidity and pain medications were related, respectively, to transfusion requirement s 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 o f surgical approach seems to be the crucial factor in determining the lengt h of the postoperative course.