Laparoscopic splenectomy for massive splenomegaly

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Abi Vainstein, Ram Spira, Vered Avidan, Yaron Armon, Joseph Alberton,
Petachia Reissman
Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel

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.

Two years experience (2003-4) of consecutive elective Laparoscopic
splenectomy was reviewed. Data regarding indication, size, operative data
and postoperative outcome were recorded.

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).

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.