The Clinic Comparative Study Between Total Laparoscopic Splenectomy And Pericardial Devascularization Versus Open Surgery

Since it was first performed by Delaitre et al in 1991, laparoscopic splenectomy has become a common laparoscopic procedure,due to its benefits including minimal invasion, less pain, faster recovery. Recently, there are many reports of total laparoscopic splenectomy and paraesophagogastric devascularization in China. The results showed that total laparoscopic splenectomy and paraesophagogastric devascularization is a safe, efficacious, feasible alternative to open surgery. However, several authors suspected advantages of the minimally invasive in total laparoscopic splenectomy and pericardial devascularization. Furthermore, there is no report of the clinic comparative study of total laparoscopic splenectomy and pericardial devascularization versus open surgery so far.The study was to retrospectively analyze the clinical data of total laparoscopic splenectomy and pericardial devascularization versus open surgery from October2004 to December 2006 in Sir Run Run Shaw Hospital Affiliated Zhejiang University School of Medicine, and to investigate feasibility, benefits and skills of total laparoscopic splenectomy and pericardial devascularization's clinical application.MethodsWe analyzed the clinical data of total laparoscopic splenectomy and pericardial devasculanzation and open surgery from October 2004 to December 2006 in Sir Run Run Shaw Hospital Affiliated Zhejiang University School of Medicine retrospectively, ruling out the data of emergency surgery, splenectomy and pericardial devasculanzation with cholecystectomy or exploration of the common bile duct and so on. There were 15 patients undergoing total laparoscopic splenectomy and pericardial devascularization( not including 10 patients conversion to open surgery).There were 28 patients undergoing open splenectomy and pericardial devascularization, and 6 patients were ruled out for length of spleen exceeding 27 cm by CT or ultrasound examination. 15 cases of total laparoscopic procedure were obserative group, 22 cases of open surgery were control group. The two groups of preoperation were no statistical difference in gender,age,type of hepatic cirrhosis, hepatic function(Child class),length of spleen,history of bleeding from the upper alimentarytract(p>0.05).Clinical data of observative group and control group were compared in respect of operation duration, intraoperative blood loss , length of postoperative hospitalization, incidence of postoperative complications and cost of hospitalization.All dates were analyzed using the Statistical Package for Social sciences software program (SSPS 11.0 for Windows), t test or x~2 test was applied. Differences with P-value less than 0.05 were considered significant.ResultThe operative time of observative group and control group was 276.7± 40.1min and 198.6 ± 58.3min (p<0.01) , intraoperaive blood loss was 476.7± 177.0ml and 777.3 ±423. 1ml (p<0.05 ), length of postoperative hospitalization was 10.5 ± 3.5d and 15.3 ± 7.5d(p<0.05), postoperative complications were 4 examples and 11 examples and two groups weren't died cases (p<0.05 ) , cost of hospitalization were RMB 44789.3 ± 11924.5 and RMB 36434.6 ± 14895.6 respectively (p>0.05) .ConclusionTotal laparoscopic splenectomy and pericardial devascularization is a minimal invasive surgical technique, with less blood loss, faster recovery, less incidence postoperative complications ,but with a longer operating room time compared with open surgery. The cost of total laparoscopic splenectomy and pericardial devascularization is more than open surgery, but the two groups are not statistically different.