Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis

Abstract

Background Surgical treatment has become the standard treatment for nontraumatic diseases of the spleen. This meta-analysis compared the relative merits of laparoscopic splenectomy (LS) with open splenectomy (OS) for nontraumatic splenic diseases. Methods A literature search was performed to identify studies comparing perioperative outcomes in patients who underwent LS or OS for nontraumatic diseases. Pooled odds ratios (ORs) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model. Results Thirty-five studies matched the selection criteria. Of the 7 269 patients included 3 981 underwent LS and 3 288 underwent OS for nontraumatic diseases. OS was associated with shorter operation time (WMD=42.65, 95% CI: 25.58-59.73), whereas LS was associated with reduced operative blood loss (WMD=-133.95, 95% CI: -229.02 to -38.88), need for blood transfusion requirement (OR=0.53, 95% CI: 0.39-0.72), overall postoperative morbidity rate (OR=0.44, 95% CI: 0.38-0.51), postoperative mortality rate (OR=0.38, 95% CI: 0.24-0.59), and length of hospital stay (WMD = -2.73, 95% CI: -3.34 to -2.12). Conclusions LS is superior to OS for nontraumatic diseases, with reduced operative blood loss, need for blood transfusion, postoperative morbidity and mortality rates, and length of hospital stay, although OS is associated with reduced operation time. LS may be a good alternative to OS for patients with nontraumatic splenic diseases.