Laparoscopic splenectomy after trauma: Who, when and how. A systematic review Fransvea P, Costa G, Serao A, Cortese F, Balducci G, Sganga G, Marini P,

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Laparoscopic splenectomy after trauma: Who, when and how. A systematic review Pietro Fransvea¹, Gianluca Costa², Angelo Serao³, Francesco Cortese⁴, Genoveffa Balducci², Gabriele Sganga¹, Pierluigi Marini⁵ ¹ Division of Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, Ariccia, Italy ² Surgical and Medical Department of Translational Medicine, Sant' Andrea Teaching Hospital, Sapienza University of Rome, Ariccia, Italy ³ Department of General Surgery, Ospedale Dei Castelli, Ariccia, Italy ⁴ Emergency Surgery and Trauma Care Unit, St Filippo Neri Hospital, Rome, Italy ⁵ Department of General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy Correspondence Address: Pietro Fransvea, Division of Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, Rome Italy Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmas.JMAS_149_19 PMID: 31670290

Importance: A deep knowledge of the indication for laparoscopic splenectomy (LS) in trauma case can lead trauma surgeon to offer in a wider number of situations a minimally invasive approach to a common injuries. Objective: To present and review the advantages and disadvantages of laparoscopic approach for spleen trauma and to identify patient whose can benefit from a minimally invasive approach versus patient that need open surgery to assess the whole severity of trauma. Evidence Review: A systematic review was performed according to the PRISMA statement in order to identify articles reporting LS after trauma. A literature search was performed through MEDLINE (through PubMed), Embase and Google Scholar from January 1990 to December 2018. Studies conducted on animals were not considered. All other laparoscopic procedures for spleen trauma were excluded. Results: Nineteen articles were included in this study, reporting 212 LS after trauma. The most study includes blunt trauma patient. All LS were performed in haemodynamically stable patient. Post-operative complications were reported in all articles with a median post-operative morbidity rate of 30 patients (14.01%), including 16 (7.5%) post-operative deaths. Conclusions and Relevance: This article reports the feasibility and safety of a minimally invasive approach for common trauma injuries which can help non-advanced laparoscopic skill trauma surgeon to develop the best indication to when to adopt this kind of approach.

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    -  Fransvea P
    -  Costa G
    -  Serao A
    -  Cortese F
    -  Balducci G
    -  Sganga G
    -  Marini P

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