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Hand‐assisted versus conventional laparoscopic splenectomy: a systematic review and meta‐analysis
Author(s) -
Qian Daohai,
He Zhigang,
Hua Jie,
Gong Jian,
Lin Shengping,
Song Zhenshun
Publication year - 2014
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12597
Subject(s) - medicine , confidence interval , meta analysis , cls upper limits , odds ratio , splenectomy , randomized controlled trial , medline , surgery , spleen , political science , optometry , law
Background Hand‐assisted laparoscopic splenectomy ( HALS ) has been widely applied for the resection of larger spleens. We conducted a systematic review and meta‐analysis to evaluate the safety and feasibility of HALS compared with conventional laparoscopic splenectomy ( CLS ). Methods A comprehensive literature search in MEDLINE , EMBASE and C ochrane L ibrary databases was performed to compare clinical outcomes of CLS and HALS . Data were extracted by two independent reviewers. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated by meta‐analytic software. Results Nine non‐randomized controlled studies for a total of 463 patients were selected to satisfy the inclusion criteria ( HALS versus CLS : 170 versus 293, respectively). The groups were similar in operative time, estimated operative blood loss, length of hospital stay, mortality and intraoperative and post‐operative complications. There was a significantly reduced conversion rate in the HALS versus CLS group (odds ratio: 2.98; 95% confidence interval 1.28 to 6.93; P = 0.01). Splenic weights in the HALS group were higher than in the CLS group (weighted mean differences: −0.93; 95% confidence interval −1.74 to −0.11; P = 0.03). Conclusion HALS may be preferable to CLS for the treatment of patients with enlarged spleens. The result needs to be certified by further random controlled trials.