Laparoscopic splenectomy feasible for at least some trauma patients

Last Updated: 2016-09-06

By Rob Goodier

NEW YORK (Reuters Health) - Outcomes of laparoscopic splenectomy in trauma cases appear to be similar to outcomes after open surgery, a new study suggests.

Laparoscopy should be reserved for stable trauma patients, however, according to research presented September 1 at the Minimally Invasive Surgery Week conference in Boston, Massachusetts.

"The old dictum that laparoscopic surgery is contraindicated in trauma patients does not hold," the study's lead author, Dr. Nabeel Zafar, Chief Resident in General Surgery at Howard University Hospital in Washington, DC, told Reuters Health by email.

Dr. Zafar reported on 83 trauma patients who underwent laparoscopic splenectomy, using data on 13,408 open surgeries recorded in the National Trauma Database for comparison.

Multivariable analysis after propensity score matching found no significant differences between the two methods for mortality, major complications and postoperative length of stay in the hospital.

For trauma patients, laparoscopy may yet prove to have the advantages that it holds in elective surgery, such as shorter length of stay, but a bigger sample is needed, Dr. Zafar wrote in the slides for his talk.

"Laparoscopy is a tool that when appropriate, can be utilized in patients suffering from isolated traumatic splenic injury," said Dr. Karen Gibbs, a bariatric surgeon at Staten Island University Hospital in Staten Island, New York who moderated the session at which Dr. Zafar presented his findings.

"A patient's underlying clinical condition will determine whether a laparoscopic approach can/should be considered. Unfortunately, splenic injuries do not often afford us this luxury," Dr. Gibbs told Reuters Health.

This study's findings reflect an evolution in the management of blunt splenic injury over the past 10 years, said Dr. Michael S. Kavic, Professor Emeritus of Surgery at Northeast Ohio Medical University and editor in chief of the Journal of the Society of Laparoendscopic Surgeons.

The important information is that laparoscopic splenectomy for select cases of trauma may be safe with a shorter post-operative length of stay, Dr. Kavic said in an email. "However," he added, "surgeon experience is critical and laparoscopic management of splenic injury requires a surgeon with well-rounded skills in laparoscopic technique."

SOURCE: http://bit.ly/2chLGAZ

Minimally Invasive Surgery Week 2016.