Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)
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Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS.
An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon.
Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient’s age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon’s preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS.
Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
- Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)
Volume 22, Issue 4 , pp 821-848
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- Author Affiliations
- 1. Institute for Research in Operative Medicine, University Witten/Herdecke, Witten/Herdecke, IFOM, Ostmerheimer Straße 200, 51109, Köln, Germany
- 2. Department of Visceral and Thoracic Surgery, Clinique Ste.Thérèse, Luxemburg, Luxemburg
- 3. Departement de Chirurgie, Hopital Cochin, Paris, France
- 4. Department of Abdominal Surgery and Transplantation, St. Luc University Hospital, Louvain Medical School, Brussels, Belgium
- 5. First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens, Greece
- 6. Division of Haematology and Haemostaseology, Medical University, Vienna, Austria
- 7. Department of Surgery, Norfolk and Norwich University Hospital, Norwich, UK
- 8. Department of General Surgery “Paride Stefani,” Policlinico Umberto I, University La Sapienza, Rome, Italy
- 9. Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- 10. Department of General and Digestive Surgery, Hospital Sant Pau, Barcelona, Spain
- 11. Department of Miniinvasive Surgery, Sanremo Hospital, Sanremo, Italy