The usefulness of modified splenic hilum hanging maneuver in laparoscopic splenectomy, especially for patients with huge spleen: a case-control study with propensity score matching.
Conversion surgery
Laparoscopic splenectomy
Propensity score matching
Spleen volume
Splenic hilum hanging maneuver
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
09
09
2020
accepted:
27
01
2021
pubmed:
18
2
2021
medline:
4
3
2022
entrez:
17
2
2021
Statut:
ppublish
Résumé
Although Laparoscopic splenectomy (LS) have been proven to the standard operation for removal of spleen, the rate of conversion to open surgery is still higher than those of other laparoscopic surgeries, especially for huge spleen. In order to reduce the rate of conversion to open surgery, we had developed LS using modified splenic hilum hanging (MSHH) maneuver: the splenic pedicle was transected en bloc using a surgical stapler after hanging splenic hilum with an atraumatic penrose drain tube. Between January 2005 and December 2019, we retrospectively assessed 94 patients who underwent LS. MSHH maneuver was performed in 37 patients (39.4%). We compared the intra- and postoperative outcomes between patients with or without MSHH maneuver. To adjust for differences in preoperative characteristics and blood examination, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 29 patients per group. Predictive factors of conversion from LS to open surgery were elucidated using the uni- and multi-variate analyses. After the propensity score matching, blood loss (268 ml vs. 50 ml), the rate of conversion to open surgery (27.6% vs. 0%), and postoperative hospital stays (15 days vs. 10 days) were significantly decreased in patients with MSHH maneuver, respectively. Among 94 patients, 19 patients (20.2%) underwent conversion to open surgery. In multivariate analysis, spleen volume (SV) and LS without MSHH maneuver were independent predictive factors of conversion to open surgery, respectively. Additionally, cut-off value of SV for conversion to open surgery was 802 ml (sensitivity: 0.684, specificity: 0.827, p < 0.001). LS using MSHH maneuver seems to be useful surgical technique to improve intraoperative outcomes and reduce the rate of conversion from LS to open surgery resulting in shorten postoperative hospital stay.
Sections du résumé
BACKGROUND
Although Laparoscopic splenectomy (LS) have been proven to the standard operation for removal of spleen, the rate of conversion to open surgery is still higher than those of other laparoscopic surgeries, especially for huge spleen. In order to reduce the rate of conversion to open surgery, we had developed LS using modified splenic hilum hanging (MSHH) maneuver: the splenic pedicle was transected en bloc using a surgical stapler after hanging splenic hilum with an atraumatic penrose drain tube.
METHODS
Between January 2005 and December 2019, we retrospectively assessed 94 patients who underwent LS. MSHH maneuver was performed in 37 patients (39.4%). We compared the intra- and postoperative outcomes between patients with or without MSHH maneuver. To adjust for differences in preoperative characteristics and blood examination, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 29 patients per group. Predictive factors of conversion from LS to open surgery were elucidated using the uni- and multi-variate analyses.
RESULTS
After the propensity score matching, blood loss (268 ml vs. 50 ml), the rate of conversion to open surgery (27.6% vs. 0%), and postoperative hospital stays (15 days vs. 10 days) were significantly decreased in patients with MSHH maneuver, respectively. Among 94 patients, 19 patients (20.2%) underwent conversion to open surgery. In multivariate analysis, spleen volume (SV) and LS without MSHH maneuver were independent predictive factors of conversion to open surgery, respectively. Additionally, cut-off value of SV for conversion to open surgery was 802 ml (sensitivity: 0.684, specificity: 0.827, p < 0.001).
CONCLUSIONS
LS using MSHH maneuver seems to be useful surgical technique to improve intraoperative outcomes and reduce the rate of conversion from LS to open surgery resulting in shorten postoperative hospital stay.
Identifiants
pubmed: 33594584
doi: 10.1007/s00464-021-08348-7
pii: 10.1007/s00464-021-08348-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
911-919Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
Références
Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach. Report of a case. Presse Med 20:2263
pubmed: 1838167
Matharoo GS, Afthinos JN, Gibbs KE (2014) Trends in splenec- tomy: where does laparoscopy stand. JSLS 18(e2014):00239
Poulin E, Thibault C, Mamazza J, Girotti M, Côté G, Renaud A (1993) Laparoscopicsplenectomy: clinical experience and the role of preoperative splenic artery embolization. Surg Laparosc Endosc 3:445–450
pubmed: 8269261
Van Der Veken E, Laureys M, Rodesch G, Steyaert H (2016) Perioperative spleen embolization as a useful tool in laparoscopic splenectomy for simple and massive splenomegaly in children: a prospective study. Surg Endosc 30:4962–4967
doi: 10.1007/s00464-016-4838-5
Gelmini R, Romano F, Quaranta N, Caprotti R, Tazzioli G, Colombo G, Saviano M, Uggeri F (2006) Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device. Surg Endosc 20:991–994
doi: 10.1007/s00464-005-0470-5
Schaarschmidt K, Kolberg-Schwerdt A, Lempe M, Saxena A (2002) Ultrasonic shear coagulation of main hilar vessels: a 4-year experience of 23 pediatric laparoscopic splenectomies without staples. J Pediatr Surg 37:614–616
doi: 10.1053/jpsu.2002.31620
Misawa T, Yoshida K, Iida T, Sakamoto T, Gocho T, Hirohara S, Wakiyama S, Ishida Y, Yanaga K (2009) Minimizing intraoperative bleeding using a vessel-sealing system and splenic hilum hanging maneuver in laparoscopic splenectomy. J Hepatobiliary Pancreat Surg 16:786–791
doi: 10.1007/s00534-009-0175-6
Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R (2001) Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 193:109–111
doi: 10.1016/S1072-7515(01)00909-7
Mizuno S, Isaji S, Tanemura A, Kishiwada M, Murata Y, Azumi Y, Kuriyama N, Usui M, Sakurai H, Tabata M (2014) Anterior approach to the superior mesenteric artery by using nerve plexus hanging maneuver for borderline resectable pancreatic head carcinoma. J Gastrointest Surg 18:1209–1215
doi: 10.1007/s11605-014-2495-3
Kuroki T, Tajima Y, Kitasato A, Adachi T, Kanematsu T (2010) Pancreas-hanging maneuver in laparoscopic pancreaticoduodenectomy: a new technique for the safe resection of the pancreas head. Surg Endosc 24:1781–1783
doi: 10.1007/s00464-009-0814-7
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
doi: 10.1097/01.sla.0000133083.54934.ae
Bassi C, Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years After. Surgery 161:584–591
doi: 10.1016/j.surg.2016.11.014
Austin PC (2009) Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations. Biom J 51:171–184
doi: 10.1002/bimj.200810488
Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European association for endoscopic surgery (EAES). Surg Endosc 22:821–848
doi: 10.1007/s00464-007-9735-5
Rehman S, Hajibandeh S, Hajibandeh S (2019) A systematic review and meta-analysis of anterior versus lateral approach for laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech 29:233–241
doi: 10.1097/SLE.0000000000000627
Di Sandro S, Danieli M, Ferla F, Lauterio A, De Carlis R, Benuzzi L, Buscemi V, Pezzoli I, De Carlis L (2018) The current role of laparoscopic resection for HCC: a systematic review of past ten years. Transl Gastroenterol Hepatol 3:68
doi: 10.21037/tgh.2018.08.05
Simorov A, Shaligram A, Shostrom V, Boilesen E, Thompson J, Oleynikov D (2012) Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers. Ann Surg 256:462–468
doi: 10.1097/SLA.0b013e3182657ec5
Habermalz B, Sauerland S, Decker G, Delaitre B, GigotLean- drosLechnerRhodesSilecchiaSzoldTargaronaTorelliNeugebauer JFEKMGAEPE (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European association for endoscopic surgery (EAES). Surg Endosc 22:821–848
doi: 10.1007/s00464-007-9735-5
Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, O’Rourke N, Nathanson L, Fielding G (2003) Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 238:235–240
pubmed: 12894017
pmcid: 1422687
Kawanaka H, Akahoshi T, Kinjo N, Harimoto N, Itoh S, Tsutsumi N, Matsumoto Y, Yoshizumi T, Shirabe K, Maehara Y (2015) Laparoscopic splenectomy with technical standardization and selection criteria for standard or hand-assisted approach in 390 patients with liver cirrhosis and portal hypertension. J Am Coll Surg 221:354–366
doi: 10.1016/j.jamcollsurg.2015.04.011
Wang X, Li Y, Crook N, Peng B, Niu T (2013) Laparoscopic splenectomy: a surgeon’s experience of 302 patients with analysis of postoperative complications. Surg Endosc 27:3564–3571
doi: 10.1007/s00464-013-2978-4
Casaccia M, Sormani MP, Palombo D, Dellepiane C, Ibatici A (2019) Laparoscopic splenectomy versus open splenectomy in massive and giant spleens: should we update the 2008 EAES guidelines? Surg Laparosc Endosc Percutan Tech 29:178–181
doi: 10.1097/SLE.0000000000000637
Rodriguez-Otero Luppi C, Targarona Soler EM, Balague Ponz C, Pantoja Millan JP, Turrado Rodriguez V, Pallares Segura JL, Bollo Rodriguez J, Trias Folch M (2017) Clinical, anatomical, and pathological grading score to predict technical difficulty in laparoscopic splenectomy for non-traumatic diseases. World J Surg 41:439–448
doi: 10.1007/s00268-016-3683-y
Liu P, Li Y, Ding HF, Dong DH, Zhang XF, Liu XM, Lv Y, Xiang JX (2020) A novel preoperative scoring system to predict technical difficulty in laparoscopic splenectomy for non-traumatic diseases. Surg Endosc. https://doi.org/10.1007/s00464-019-07327-3
doi: 10.1007/s00464-019-07327-3
pubmed: 33258028
pmcid: 8437885