Hand-assisted versus conventional laparoscopic splenectomy: a systematic review and meta-analysis.

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 Cochrane Library 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.