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Comparison of Laparoscopic, HALS and Open Surgery for Elective Splenectomy
*Usman Ahmad, *Amir H Shariff, Ronald R Salem
Department of Surgery, Yale University, School of Medicine, New Haven, CT

To compare the peri-operative variables and outcomes of open (OS), laparoscopic (LS) and lap-hand assisted splenectomy (HALS) procedures.
Retrospective case-series
Elective splenectomies performed at a tertiary care center.
Patients age >16 years, who underwent elective splenectomy between 1990-2010, were included.
Main Outcomes:
Demographics, operative time, blood loss (EBL), splenic size, length of stay (LOS) and complications
During the study period 108 patients had splenectomy; OS (52, 48%), HALS (9, 8.3%) and LS (47, 44%). Age and gender distributions were similar in the 3 groups. Mean ASA was significantly higher in OS group (2.7 vs HALS-2.2 and LS-2.4, p<0.05). ITP was the most common operative indication. Operative time was significantly longer in LS (180±42 vs HALS-127±66 and OS-142±46 minutes, p<0.00). There was no difference in EBL, (OS-376±421ml, HALS-225±259ml and LS-265±298ml), however 11(21%) OS patients had intra-operative blood transfusions vs HALS-0 and LS 5(11%). There were 3 (6%) intra-op complications in LS group vs 1 (1.9%) in OS. LS group resumed regular diet sooner (2.5±1.1 vs HALS 2.7±1.6 and OS 4.1±1.2 days, p<0.000), and had shorter hospital stay (3±1.3, vs HALS-2.9±1.6 and OS5.1±2 days, p<0.000). Splenic weight and dimensions were significantly greater in OS group (p<0.000). Post-operatively OS had a higher rate of ICU admission 9.6% vs HALS-0 and LS 4.3%. There was 1 death in the OS group.
LS resulted in more intra-operative complications, however had faster pos-operative recovery. There was no difference in EBL, blood transfusions, resumption of diet and LOS between LS and HALS. Splenomegaly led mostly to OS, which was associated with more ICU admissions and longer length of stay.

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