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Updated: Aug 5, 2026
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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Trends in laparoscopic splenectomy for massive splenomegaly
Sarah W Grahn1, Jesus Alvarez, Kimberly Kirkwood
1Department of Surgery, University of California, San Francisco, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|August 23, 2006
Summary
Laparoscopic splenectomy (LS) is safe and effective for massive spleens, reducing hospital stays and improving outcomes. Increased surgical experience has led to a decline in conversion rates and better patient results.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Laparoscopic splenectomy (LS) expertise has grown over the past decade.
- This has led to increased success rates, even for patients with massive or supramassive spleens.
Purpose of the Study:
- To evaluate the safety and efficacy of LS for massive and supramassive spleens.
- To assess the impact of institutional experience on LS outcomes.
Main Methods:
- Retrospective analysis of 111 adult patients undergoing elective splenectomy between 1995 and 2005.
- Data collected included spleen size, conversion rates, length of stay, and complications.
- Massive splenomegaly defined as spleen length >17 cm or weight >600 g; supramassive as length >22 cm or weight >1600 g.
Main Results:
- 77% of patients (85/111) underwent LS, with 29% (25/85) having massive or supramassive spleens.
- Conversion rates for massive/supramassive spleens decreased from 33% pre-1999 to 0% in 2004-2005.
- LS for massive/supramassive spleens resulted in no reoperations for bleeding or deaths and a shorter postoperative stay (3.8 vs 9.0 days).
Conclusions:
- LS is a safe and effective approach for massive splenomegaly, contrary to some reports.
- Increasing institutional experience improves LS safety, reduces length of stay, and enhances mortality.
- Laparoscopic splenectomy offers significant benefits over open surgery for patients with enlarged spleens.
