Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?

Area of Science:

• Surgical Gastroenterology
• Abdominal Imaging
• Minimally Invasive Surgery

Background:

• Accessory spleens (AcS) are found in approximately 20% of patients and may necessitate removal during splenectomy for optimal hematological response.
• Laparoscopic splenectomy (LS) is a common surgical approach for splenectomy.

Purpose of the Study:

• To evaluate the diagnostic benefit of computed tomography (CT) in detecting accessory spleens (AcS) prior to laparoscopic splenectomy (LS).

Main Methods:

• Prospective study involving 58 patients undergoing LS for splenectomy.
• Preoperative contrast-enhanced CT scans were performed to identify and locate AcS.
• Surgeons were aware of CT findings.
• Patients were followed postoperatively for disease recurrence.

Main Results:

• CT detected 11 AcS in 11 patients (19%); 9 were confirmed during LS.
• LS identified 14 AcS in 13 patients (22%), with 4 missed by preoperative CT.
• Laparoscopy demonstrated significantly higher sensitivity (93.3%) and specificity (100%) for AcS detection compared to CT (60% and 95.6%).
• Area under the ROC curve was significantly higher for laparoscopy (0.967) than for CT (0.673; P = 0.004).

Conclusions:

• Accessory spleens are easily detectable during laparoscopic splenectomy.
• Preoperative CT scanning for AcS detection and localization may not be essential before LS.
• Intraoperative laparoscopic findings for AcS are superior to preoperative CT.