Comparative Analysis Of Laparoscopic Versus Open Splenectomy

BackgroundSince the first report of laparoscopic splenectomy by Delaitre in 1991, this technique has developed rapidly due to its advantage of minimal incision, quick recovery and little complication. In many hospitals, LS has become the first choice of curing hematopathy, especially idiopathic thrombocytopenic purpura(ITP). Now there are two methods to deal with splenic pedicle vessels in LS. One is to use Endo-GIA which has the advantage of convenience and rapid. But sometimes it can cause hemorrhage and artery-vein fistula. And its high price is beyond the afford of some patients, which limit its generalization. Recently, some doctors use secondary pedicle division strategy in LS, which significantly reduce the operation cost, and makes LS popular. ObjectiveTo discuss the feasibility of LS through comparative analysis of open splenectomy versus Endo-GIA strategy and secondary pedicle division strategy inLS. MethodsFrome January 2003 to July 2006, patients received splenectomy in Sir Run Run Shaw hospital were studied retrospectively. We record the operative time, blood loss during operation, postoperative eating time, drainage time, postoperative hospital stay and hospitalization cost. Statistical analysis are made using SPSS 13.0 for windows. ResultsThere are 41 cases enrolled in Sir Run Run Shaw hospital from January 2003 to July 2006, in which 10 cases are through open splenectomy, 12 cased are through Endo-GIA strategy in LS and 19 cases are through secondary pedicle division strategy in LS. No complication were found. There's no significant differences among the open group, Endo-GIA group and secondary pedicle group in blood loss during operation(260.00±142.98 ml, 225.00±105.53 ml and 217.65±204.59 ml respectively ) and postoperative eating time(2.30±0.95 days, 1.92±0.99 days and 1.47±0.79days respectively). The operative time of Endo-GIA group( 184.75±49.63 minutes ) is much longer than open group (100.00±27.89 minutes)and secondary pedicle group(132.35±40.37 minutes) , and there's no significant differences between the open group and secondary pedicle group. The postoperative hospital stay of open group(6.60±1.17 days) is much longer than Endo-GIA group (5.00±0.85 days)and secondary pedicle group(5.00±1.28 days) , and there's no significant differences between the open group and secondary pedicle group. Thehospitalization cost of Endo-GIA Group (￥22390.83±2210.33) is much more than secondary pedicle group (￥14508.65±2811.33) while secondary pedicle group is much more than open group (￥9724.40±1319.98). ConclusionLaparoscopic splenectomy is safe and effect to some splenic disease which satisfy the indication. Though its operation time is longer than open splenectomy , there's no significant differences in blood loss and postoperation eating time between the two operations. And the postoperative hospital stay of laparoscopic splenectomy is shorter than open splenectomy. But the high cost limit the generalization of laparoscopic splenectomy. Secondary pedicle division strategy can reduce the operation cost, and blood loss, postoperation eating time and postoperative hospital stay are comparable to Endo-GIA strategy in LS, so it is strong recommended to be generalized in our country.