Laparoscopic vs open splenectomy

Hypothesis: Laparoscopic splenectomy (LS) provides health benefits to patients compared with open splenectomy (OS) in terms of perioperative morbidity, complications, and patient recuperation. Design: Prospective operative and outcome data of LS patients were compared with those of OS patients (historical controls). Setting: Data were gathered, and patients were evaluated and treated at 2 McMaster University teaching hospitals in Hamilton, Ontario, and at the University of Kentucky Chandler Medical Center, Lexington, also a teaching hospital. Patients: From January 1, 1994, through October 31, 1998, a total of 210 patients were studied. Of them, 147 patients from 3 university teaching hospitals underwent LS. These patients were matched with 63 OS patients according to age, sex, spleen weight, indication for splenectomy, and preoperative morbidity score. Interventions: A total of 147 patients evaluated for elective splenectomy underwent LS. Main Outcome Measures: Spleen weight, operative time, intraoperative blood loss, postoperative hospital stay, perioperative complications, and cost. Results: No significant difference in mean spleen weight was found between groups. Mean operative time was significantly longer for LS, but intraoperative blood loss was significantly lower. Mean postoperative hospital stay was significantly lower and perioperative complications significantly fewer for LS patients. Mean cost for LS with no complications was slightly lower than for OS. Conclusions: Compared with OS, the lateral approach to LS takes longer to perform but results in reduced blood loss, shorter postoperative stay, and fewer complications. Mean weighted cost of LS is lower than OS at the study institutions. A prospective, randomized, controlled trial comparing these techniques is planned.