Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2019; 7(3): 320-334
Published online Feb 6, 2019. doi: 10.12998/wjcc.v7.i3.320
Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A meta-analysis
Yong Huang, Xiao-Yun Wang, Kai Wang
Yong Huang, Kai Wang, Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Xiao-Yun Wang, Department of Operating Room, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: All the authors equally contributed to this work.
Supported by the National Natural Science Foundation of China, No. 81760514; and Youth Science Fund of Jiangxi Provincial Science and Technology Department, No. 20161BAB215252.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kai Wang, MD, PhD, Professor, Department of General Surgery, Hepato-Biliary-Pancreatic Surgery Division, The Second Affiliated Hospital of Nanchang University, No. 1, Mingde Road, Nanchang 330006, Jiangxi Province, China. neswk@163.com
Telephone: +86-791-86259319 Fax: +86-791-86259319
Received: November 6, 2018
Peer-review started: November 8, 2018
First decision: December 10, 2018
Revised: December 26, 2018
Accepted: January 3, 2019
Article in press: January 3, 2019
Published online: February 6, 2019
Processing time: 85 Days and 17.1 Hours
Abstract
BACKGROUND

Hand-assisted laparoscopic splenectomy (HALS) can help overcome the drawbacks of laparoscopic splenectomy (LS) while maintaining its advantages.

AIM

To evaluate the efficacy and advantages of HALS for splenomegaly.

METHODS

The relevant literature was reviewed using the PubMed, EMBASE, Cochrane, Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from 16 trials who met the inclusion criteria were selected.

RESULTS

In pure splenectomy, blood loss volume (P < 0.001) and conversion rate (P = 0.008) were significantly lower in the HALS group than in the LS group. Conversely, for splenomegaly, the operative time (P = 0.04) was shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach (DUS), the operative time (P = 0.04) was significantly shorter and blood loss volume (P < 0.001) and conversion rate (P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.

CONCLUSION

HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.

Keywords: Hand-assisted; Laparoscopic; Splenectomy; Splenomegaly; Devascularization

Core tip: Hand-assisted laparoscopic splenectomy (HALS) can help overcome the drawbacks of laparoscopic splenectomy (LS) while maintaining its advantages, but it is not widely accepted. Our study demonstrated that HALS can significantly benefit patients with splenomegaly while maintaining the advantages of LS and the tactile sense of open splenectomy. Moreover, as it improves the safety of surgery, it is a good alternative.