Comparative Study between Anterior and Lateral Approaches of Laparoscopic Splenectomy

Abstract Background: The primary basis of treatment for ITP and many hematological disorders was splenectomy. There are many approaches and techniques that have evolved for splenec-tomy. Reports of laparoscopic splenectomy began appearing in the literature in 1991 and 1992. Over time it has become the standard for elective splenectomy for both benign and malignant indications although open splenectomy remains perfectly acceptable for all indications as well. Laparoscopic splenectomy developed many techniques and approaches through last years, examples of these are anterior approach laparoscopic splenectomy, lateral approach laparoscopic splenectomy, single port laparoscopic splenectomy, hand assisted laparoscopic splenectomy (HALS). Aim of Study: The goal of this study is to compare lapar-oscopic splenectomy anterior and lateral approaches, including operative time, blood loss, surgical complications, conversion to open surgery, postoperative morbidity, postoperative length of stay, number of trocars used and blood transfusion require-ments in each approach. Materials and Methods: The present study was a rand-omized controlled prospective study with 40 patients. Indicated for splenectomy at El-Demerdash Hospital between 2018 and 2020, splenectomy was done by the same surgical team. The 40 cases in our sample were obtained from Ambulatory Clinics in University Hospitals in Ain-Shams. The closed envelope system split the patients into two classes: Group 1 including 20 patients underwent laparoscopic splenectomy using anterior approach, group 2 including 20 patients underwent laparoscopic splenectomy using lateral approach. The inclusion criteria were all adult patients indicated for surgery, fit for anesthesia and consented to participate in the study, aged between 18 to 60 years with a diagnosis of: Hematological disorder (Idio-pathic thrombocytopenic purpura ITP, Thrombotic Thrombo-cytopenic Purpura TTP, chronic hemolytic anemia except sickle cell disease), hydatid cyst, splenic tumor; as lymphoma, felty syndrome and sarcoidosis. We excluded patients with bleeding tendency due to causes other than ITP, patients with previous upper laparotomies, patients with generalized diseases that contra-indicates laparoscopic maneuvers, patients with huge splenomegaly with longitudinal axis more than 20cm and pregnancy.
Results: In the present study; there were statistically important ties between the types of approach used and both operative time and number of ports., we found that the lateral approach had a shorter operative time; as well as, the number of ports was less in lateral approach. On the contrary there was no statistically significant difference between two types of approach in terms of age, body mass index (BMI), gender, indication of surgery, complete blood count (CBC) findings, spleen size, blood loss, vascular or visceral injury, conversion to open surgery, hospital stay and post-operative complications (chest infection, wound infection, pancreatic leak and acute gastric dilatation). Conclusion: We find that for laparoscopic splenectomy, the lateral approach has a greater intraoperative benefit than the anterior approach. The lateral solution was connected to much shorter operative times and a smaller number of ports.