Laparoscopic splenectomy: An evolving technique - A comparison between anterior and lateral approaches

Background: The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Laparoscopic splenectomy (LS) suffers from several technical problems for mobilization and manipulation of a solid organ. Lateral approach has been proposed as an alternative to the anterior approach which facilitates LS. The aim of this paper is to compare the results of LS using and anterior or lateral approach. Methods: Between February 1993 and May 1995, 27 LS were performed (group I, Ant-LS, n: 10; group II, Lat-SL, n: 17). LS was indicated in 19 patients for treatment of an idiopathic purpura, for spherocytosis in four; for AIDS-related thrombocytopenia in two; and for autoimmune anemia and leucopenia in two, Gallstones were associated in two cases and an ovarian cyst in another. Results: LS was completed in 8 patients of group I (80%) and 17 of group IT (100%). Operative time (236 +/- 21 min vs 159 +/- 71 min p < 0.003), number of trocars (4.5 +/- 0.5 vs 4 +/- 0.5, p < 0.02), transfusion requirements (60 vs 17%, p < 0.04) and mean stay (6.5 +/- 3.6 days vs 4 +/- 2 days, p < 0.05) were significantly lower in the group of LS with a lateral approach. Conclusions: The lateral approach significantly facilitates the performance of LS compared with the anterior approach. The physical characteristics of the spleen and its anatomic location pose important technical problems for its mobilization and vascular control of the pedicle, which entail a long operation and an increased risk of bleeding (Table 1). Recently, Gagner et al. [5] have proposed a technical variation that facilitates LS. The spleen is approached with the patient positioned in right lateral decubitus, which provides a suitable visualization of the posterior face of the spleen. The aim of this paper is to compare the results of anterior with lateral approach for LS.