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The laparoscopic splenectomy and massive splenomegaly - should we expect more complications?

Background. The massive splenomegaly still presents a challenge and even relative contraindication for LS. The spleen size is usually not considered as an absolute contraindication, but on the other hand literature suggest the higher rate of complications associated to massive splenomegaly. Through the report of our experience we analyzed the outcomes of laparoscopic splenectomy in the setting of splenomegaly and massive splenomegaly in order to assess whether the massive splenomegaly increases the risk for complications. Methods: We performed analysis of 50 patients underwent to laparoscopic splenectomy (LS) whose data was prospectively recorded. Data collection included age, gender, the nature of splenic disease, ASAclassification, BMI, spleen size , number of ports used, operative time, concomitant operation, perioperative or postoperative requirements for transfusion, conversion to open surgery, mode of splenic hilum ligation, length of hospital stay, postoperative morbidity and mortality According to spleen size the patients were classified in three groups: normal spleen size group in whom the longest axis of the spleen did not exceed 15 cm (26/50, 52%), splenomegaly group (14/50, 28% cases) and massive splenomegaly group (10/50, 20%cases). We analyzed whether the massive splenomegaly (splenic size ≥20 cm) increases the risk for LS in comparison to data in patients with normal spleen size or splenomegaly up to 20 cm in diameter. Results: Majority of our 50 patients submitted to LS had benign splenic disease (40/50, 80%), and almost half of them had enlarged spleens (24/50, 48%). There were no differences in age, gender, ASA classification and BMI between three spleen size groups. In normal spleen size group significantly the lowest proportion of patients, had diagnoses of malignancy (3.85%vs 28.6% in splenomegaly and 50% in massive splenomegaly, P=0.005), and the duration of operation was shorter (92.50 min vs 142.80 min and 145.00 min respectively, P=0.001). Operative time was longer in malignant cases (147.50 min vs 110.00 min, P=0.018). Overall conversion rate was 12% (6 cases) with no statistical differences between three groups according to spleen size as well as no difference between benign and malignant splenic disease cases.Complications that occurred in 5 (10%) patients were more frequent in normal spleen size group (4/26, 15.38% vs 1/24, 4.17%). No deaths or infection were noticed. Portal vein thrombosis was detected in 3 (6%) of all cases and all patients suffered from benign splenic disease.Blood transfusion was necessary in nine patients (18%), and four of them were operated due to malignant disease and in all except in one case the spleen was enlarged. Mean hospital stay for all patients was 5.49 days with no differences between groups. Conclusion: Despite of longer operative time LS in the setting of massive splenomegaly is safe with no higher complication rate or morbidity.

splenectomy; massive splenemegaly

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