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Laparoscopic Splenectomy for Massive Splenomegaly: Does Size Matter?

Levan Tsamalaidze1, John A Stauffer1, Samantha L Permenter1

  • 1General Surgery, Mayo Clinic , Jacksonville, Florida.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|August 12, 2017
PubMed
Summary

Laparoscopic splenectomy (LS) is a safe and effective option for massive splenomegaly (MS), offering a shorter hospital stay. This approach challenges previous guidelines recommending against LS for MS.

Keywords:
laparoscopic splenectomymassive splenomegalysplenomegaly

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Area of Science:

  • Surgical Oncology
  • Minimally Invasive Surgery
  • Gastrointestinal Surgery

Background:

  • Laparoscopic splenectomy (LS) is common for elective splenectomy but controversial for massive splenomegaly (MS).
  • European guidelines generally do not recommend LS for MS (spleen size >20 cm).

Purpose of the Study:

  • To evaluate the safety and efficacy of LS compared to hand-assist (HALS) and open splenectomy (OS) for patients with MS.
  • To analyze operative details and patient outcomes in a retrospective cohort.

Main Methods:

  • Retrospective analysis of 229 splenectomy patients (1995-2016), with 86 having MS.
  • Comparison of LS, HALS, and OS groups regarding demographics, comorbidities, operative details, and outcomes.
  • Analysis of conversion rates, morbidity, mortality, and postsplenectomy thrombosis.

Main Results:

  • No significant differences in demographics, comorbidities, or spleen size across LS, HALS, and OS groups.
  • Similar operative times and blood loss between groups, with low conversion rates for LS and HALS.
  • Comparable morbidity and mortality across all groups; shorter length of stay observed for LS (3.2 days) vs. HALS (4.9 days) and OS (5.2 days).

Conclusions:

  • Laparoscopic splenectomy (LS) is a safe and feasible surgical option for patients with massive splenomegaly (MS).
  • LS is associated with a significantly shorter hospital stay compared to hand-assist (HALS) and open splenectomy (OS).
  • Findings suggest LS can be considered for MS, potentially revising current clinical recommendations.