الفهرس 
EmbryologyOnly 14 pages are availabe for public view
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Abstract
Background: Since splenectomy was initially described for hereditary spherocytosis (HS) by Sutherland and Burghard in 1910 and for idiopathic thrombocytopenic Purpura (ITP) by Kanzelson in 1916, it has been well recognized as an effective cure for some hematologic disorders. Splenectomy remained the mainstay of treatment of ITP for more than 30 years until 1951, when Harrington et al., 1951 discovered the role of plasma immune globulin in the induction of thrombocytosis in ITP
Aim of the Work: The aim of this study is to make a comparison between anterior and lateral approaches of laparoscopic splenectomy including operative time, blood loss, operative complication, conversion to open surgery, postoperative morbidity, postoperative length of stay, number of trocars used in each approach, blood transfusion requirements.
Materials and Methods: The present study was a prospective, randomized, controlled study including 40 patients indicated for splenectomy at El- Demerdash hospital by the same surgical team between 2018 and 2019.The estimated sample size was 40 cases. Patients were divided into two groups by closed envelope method: group I including 20 patients underwent laparoscopic splenectomy using anterior approach, group II including 20 patients underwent laparoscopic splenectomy using lateral approach. The 40 cases of our study were collected from outpatient clinic in Ain-Shams university hospitals. The inclusion criteria were all adult patients indicated for surgery, fit for anesthesia and consented to participate in the study, aged between 18 to 60 years with a diagnosis of: hematological disorder (ITP, Thrombotic Thrombocytopenic Purpura, chronic hemolytic anemia except sickle cell disease), hydatid cyst, splenic tumor as lymphoma, felty syndrome and sarcoidosis.
Results: In the present study, there were no statistically significant associations between type of procedure and hospital stay and post-operative complications (chest infection, wound infection, pancreatic leak and acute gastric dilatation). The present study is one of the few reports which compared lateral versus anterior approach for laparoscopic splenectomy. The advantages of our study include random selection of the patients, which ensure low selection bias. The presence of control group is another advantage which ensured low performance bias.
Conclusion: We found that the lateral approach has more intraoperative advantage for laparoscopic splenectomy than the anterior approach in patients without severe splenomegaly (> 20 cm). The lateral approach was associated with significantly shorter operation times and intraoperative blood loss. The lateral approach, however, is less suitable in patients with severe splenomegaly (> 20 cm) due to technical limitations. Further studies with rigorous design, large sample size and multiregional cooperation are required.