Efficacy and Complications of Open vs. Laparoscopic Splenectomy: A Systematic Review

Mohamed Suliman Ali Almahadi; Renad Aaidh Hussain; Razan Mohammed Alotaibi; Anoud Naji Alruwaili; Abdulrahman Saeed G Alasmari; Mshary Saeed Abdullah  Alshahrani; Asrar Saeeid  Al-Saad; Yara Sulaiman  Aleidi; Shaden Khalid  Almutairi; Reema Tariq  Alkalefah

doi:10.54293/smhj.v5i3.168

Authors

Mohamed Suliman Ali Almahadi Consultant General surgeon, Hohael Asir, KSA.
Renad Aaidh Hussain Medical Student (General Medicine and Surgery), Ibn Sina National College, Jeddah, KSA.
Razan Mohammed Alotaibi Medical Student (General Medicine and Surgery), Ibn Sina National College, Jeddah, KSA.
Anoud Naji Alruwaili General Practitioner (General Medicine and Surgery), Alqurayat General Hospital, Alqurayat, KSA.
Abdulrahman Saeed G Alasmari Medical Student (General Medicine and Surgery), King Khalid University, Abha, KSA. https://orcid.org/0009-0000-3336-2639
Mshary Saeed Abdullah Alshahrani Medical Student (General Medicine and Surgery), King Khalid University, Abha, KSA. https://orcid.org/0009-0008-8598-9677
Asrar Saeeid Al-Saad Medical Intern (General Medicine and Surgery), Najran University, Najran, KSA. https://orcid.org/0009-0001-9491-9901
Yara Sulaiman Aleidi Medical Student, General Medicine and Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA. https://orcid.org/0009-0003-8026-2130
Shaden Khalid Almutairi Medical Intern, General Medicine and Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA. https://orcid.org/0009-0001-6411-6235
Reema Tariq Alkalefah Medical Intern, General Medicine and Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA. https://orcid.org/0009-0004-9815-7555

DOI:

https://doi.org/10.54293/smhj.v5i3.168

Keywords:

Splenectomy, Laparoscopic surgery, Open surgery, Portal hypertension, Postoperative complications, Minimally invasive surgery, Hematologic disorders

Abstract

Splenectomy is a critical surgical intervention for various hematologic disorders, trauma, and portal hypertension. While laparoscopic splenectomy has gained popularity due to its minimally invasive nature, debates persist regarding its comparative efficacy and safety versus open splenectomy, particularly in high-risk populations. This systematic review followed PRISMA guidelines, analyzing studies from PubMed, Web of Science, Scopus, and ScienceDirect. Six comparative studies (total number = 1,320 patients) were included, assessing operative outcomes, complications, and long-term efficacy. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Laparoscopic splenectomy demonstrated significant advantages, including reduced intraoperative blood loss (180 mL vs. 380 mL, p < 0.001), shorter hospital stays (6 vs. 11 days, p < 0.001), and lower complication rates (24.2% vs. 56.1%, p < 0.001). Operative times were longer for laparoscopy (185 vs. 144 minutes, p = 0.048), but conversion rates were low (0–4.8%). Pediatric outcomes were comparable, though laparoscopy had higher blood loss in some cases. Portal hypertension patients benefited from reduced transfusion needs (15% vs. 38%, p = 0.02) and lower portal vein thrombosis rates (8% vs. 22%, p = 0.03). Laparoscopic splenectomy is associated with superior perioperative outcomes and fewer complications compared to open splenectomy, supporting its preference in elective settings. However, surgeon expertise and patient selection remain crucial. Further randomized trials are needed to evaluate long-term immunological effects and cost-effectiveness.