Splenectomy

Laparoscopy vs. Open Surgery

Why is there an open approach and a laparoscopic approach?
The laparoscopic approach was introduced in the early 1990s based on the success observed with laparoscopic gallbladder removal. Studies to date have shown less pain, earlier return to normal activities and earlier return to work for the laparoscopic approach when compared to the open approach. It is important to realize that these differences are measured in days to weeks, not months. It is also important to recognize that everyone is different with regards to the perception of pain and occupation. One person may undergo an open splenectomy and be back to work in a week while another person undergoing a laparoscopic splenectomy only returns in 6 weeks.

Which is a better approach, the open or the laparoscopic?
The actual operation performed during a laparoscopic or open approach is the same; namely, removal of the spleen. In this regard, the laparoscopic approach would appear to be better given the fact that recovery is quicker, discharge from the hospital is earlier and the cosmetic result is significantly better. There appears to be no difference in complication rates between the two procedures. Furthermore, the rate of discovery of accessory spleens during the laparoscopic approach is at least the same as during open surgery. Some authorities argue that the laparoscopic approach may be better for identifying accessory spleens because of the magnification present during these operations. This has not been confirmed to date.

Can all patients have a laparoscopic splenectomy?
No. Patients with a very large spleen are generally best treated with an open splenectomy. The operation is considerably more difficult, more likely to not be possible and more likely to develop complications. Patients with a normal-sized spleen are all candidates for the laparoscopic approach unless they have other medical problems that put them at risk, such as severe heart or lung disease. Overall, 95% of patients with a normal- sized spleen will be able to have a splenectomy completed laparoscopically.

What factors make a patient a less than optimal candidate for a laparoscopic approach?
There are a variety of factors which decrease the chance of the surgeon being able to complete the procedure laparoscopically.

These include:

Larger spleen than anticipated
Inflammation
Previous surgery
Unclear anatomy
Pregnancy
Previously unrecognized abnormalities
An intraoperative problem, such as bleeding

Conversion of a laparoscopic procedure to an open one should not to be viewed as a complication, since some patients simply are unable to be have the surgery performed laparoscopically without undue risk. Our goal is to perform a safe and uncomplicated procedure. Therefore, we will not take unnecessary risks just to complete the procedure laparoscopically.

Do all surgeons perform both the laparoscopic and open approaches?
No. All surgeons perform the open approach but only some surgeons perform the laparoscopic approach. It is important in getting an opinion regarding your surgery to determine if the surgeon performs one or both approaches and how many of each he or she has performed.

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