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Total splenectomy (TS) is effective in reducing hemolysis and decreasing the need of transfusions, but total removal of the spleen represents a potential risk factor for infectious and non\u2010infectious complications. On the other hand, subtotal splenectomy (STS) could be an alternative therapy for HS. The aim of this study is to establish which surgical approach has the best outcome in HS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients (<jats:italic>n<\/jats:italic>\u2009=\u200963) receiving splenectomy for HS between 2002 and 2016 from one institution were retrospectively reviewed. Hemoglobin and reticulocytes levels during preoperative and postoperative follow\u2010up periods were compared. Additionally, a meta\u2010analysis was performed analyzing data regarding hemoglobin and reticulocytes levels from several available studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>At 1\u2010year follow\u2010up, our clinical data showed that mean hemoglobin levels increased after TS from (mean\u2009\u00b1\u2009SD) 9.77\u2009\u00b1\u20091.82 to 11.88\u2009\u00b1\u20092.08\u00a0g\/dl, while after STS from 8.98\u2009\u00b1\u20091.66 to 11.87\u2009\u00b1\u20091.38\u00a0g\/dl. At 3\u2010year and 5\u2010year follow\u2010up after TS, we observed an increase from 9.77\u2009\u00b1\u20091.82 to 13.59\u2009\u00b1\u20092.03 and 13.46\u2009\u00b1\u20091.64\u00a0g\/dl, respectively. At 3\u2010year and 5\u2010year follow\u2010up after STS in our cohort, we observed an increase from 8.98\u2009\u00b1\u20091.66 to 13.21\u2009\u00b1\u20091.95 and 13.68\u2009\u00b1\u20091.65\u00a0g\/dl, respectively. The meta\u2010analysis (for a follow\u2010up period of 1 year) showed that the hemoglobin levels increased with 2.61\u00a0g\/dl (95% CI 2.15\u20133.08\u00a0g\/dl; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) after TS, and with 1.67\u00a0g\/dl (95% CI 1.25\u20132.10\u00a0g\/dl; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) after STS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We conclude that subtotal and minimally invasive splenectomy could be considered as the first line of treatment in severe HS cases, especially in children.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05485-3","type":"journal-article","created":{"date-parts":[[2020,3,26]],"date-time":"2020-03-26T19:03:55Z","timestamp":1585249435000},"page":"2220-2228","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Long\u2010Term Evaluation of the Outcomes of Subtotal Laparoscopic and Robotic 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Dragomir, Raluca Purnichescu-Purtan, Stefan Tudor and Catalin Vasilescu declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}