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0061 Endo LAPAROSCOPIC SPLENECTOMY FOR MASSIVE SPLENOMEGALY Abi Vainstein, Ram Spira, Vered Avidan, Yaron Armon, Joseph Alberton, Petachia Reissman Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel BACKGROUND Laparoscopic splenectomy (LS) was shown to be the operative approach of choice for hematologic disorders involving normal sized spleens. For patients with massive splenomegaly, the laparoscopic approach is in debate due to expected technical difficulties. Our experience with laparoscopic splenectomy for massive splenomegaly is presented. PATIENTS AND METHODS Two years experience (2003-4) of consecutive elective Laparoscopic splenectomy was reviewed. Data regarding indication, size, operative data and postoperative outcome were recorded. RESULTS Out of 23 LS in the study period, 10 were for massive splenomegaly. There were 6 males (2 children) and 4 females. Mean age was 48 years (6-70). Indication for splenectomy were Lymphoma: 2, Spherocytosis: 2, Hypersplenism: 2, Myelofibrosis: 2, Tuberculosis: 1, Polycytemia Vera: 1. Mean size of spleen (craniocaudal length by preoperative imagine study) in adults was: 19 cm (±3.9) range 17-28cm. The mean weight of morcelated splenic tissue was 1503gr.(±703). Range 700-2840gr. for adults and 500gr. (380-620gr) in children. Mean operative time was 183.3 min (±58.5). The surgery was completed laparoscopically in 3, performed with a hand assisted technique in 7. Intraoperative bleeding occurred in two patients one of which was converted to an open procedure. Perioperative mean blood requirements was 1.6 unit (±1.6). Major postoperative complications occurred in 3/10 patients: pneumonia, sepsis d/t subphrenic collection and bleeding. Mean length of stay was 8.8 days (±3.3). CONCLUSIONS Although associated with a relative high morbidity rate, laparoscopic splenectomy for massively enlarged spleen is feasible and the outcome is comparable (according to literature results), to the open procedure.
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