Totally Laparoscopic Splenectomy Versus Open Splenectomy For Massive Spleen:A Meta-analysis

Objective:At present the domestic and foreign scholars agree that laparoscopic splenectomy has became the "gold standard" of minimally invasive treatment of various diseases of the spleen.Due to the anatomical characteristics of the human spleen,patients with traditional open splenectomy, generally has L-shaped incision on the abdomen.Inevitably bring patients with more surgical trauma and postoperative recovery time and need to endure great pain after surgery.In recent years, with the continuous development and improvement of laparoscopic splenectomy technology and the advent of a variety of laparoscopic instruments,Laparoscopic surgery has been gradually applied to the patients with massive spleen and the related literatures have been reported.However, it is still controversial whether the laparoscopic technique is safe and effective for massive splenectomy.In this paper,through the use of meta analysis methods to analyze clinical efficacy of TLS and OS in massive splenectomy. To further evaluate its clinical efficacy and analyze its application prospect.Methods:(1) Retrieval literature about the comparison of clinical efficacy of TLS and OS in Chinese and foreign databases(2)According to the inclusion criteria and exclusion criteria included in the qualified documents(3) Manually extract the relevant data in the literature(4) Using special evaluation system Rev Man 5.3 software for statistical analysis(5) For further analysis and interpretation of the statistical analysis of results.Results:13 papers were included in the final inclusion criteria,including a total of 746 cases,340 cases of them for LS and 406 cases of them for OS. The outcome of the meta analysis showed:there was no significant difference in the operation time between TLS and OS(p=0.07),there were significant differences in the amount of blood loss, postoperative bowel recovery time, postoperative hospital stay, and postoperative complications between the two different types of operation.Conclusions:TLS can achieve good clinical effect in the treatment of massive spleen.TLS can be considered to be a safe, minimally invasive and feasible way of massive splenectomy.But the research is still insufficient, such as the small number of cases, included literature heterogeneity, literature quality is not high etc, Still need more large sample, high quality randomized controlled clinical trials or retrospective case control study to further verify.