Laparoscopic Splenectomy: Outcomes and Conversion Trends from A 20-Year Single-Center Experience

Background: Laparoscopic splenectomy has become the preferred approach for most elective splenic indications; however, conversion to open surgery remains a relevant concern, particularly in complex cases. Long-term institutional experiences provide valuable insight into outcomes, learning curves, and evolving indications. Methods: A retrospective observational study was conducted at a tertiary referral center, including all consecutive patients who underwent laparoscopic splenectomy over a 20-year period. Demographic data, surgical indications, conversion to open surgery, and postoperative hospital stay were analyzed using descriptive statistics. Results: A total of 125 patients underwent laparoscopic splenectomy during the study period. Hemato-logic diseases represented the predominant indication, while trauma, malignant conditions, infectious and parasitic diseases, and accessory spleen removal accounted for a smaller proportion of cases. Conversion to open surgery was required in 13 patients (10.4%). A temporal analysis demonstrated a reduction in conversion rates from the first decade to the second decade of the study, reflecting improved outcomes with increasing institutional experience. Postoperative recovery was generally favorable, with a short postoperative length of hospital stay. Conclusion: Laparoscopic splenectomy is a safe and effective procedure for a broad range of splenic pathologies, most commonly hematologic disorders. Over a 20-year experience, acceptable conversion rates and favorable postoperative outcomes were achieved, with evidence of improvement over time. Careful patient selection, standardized surgical technique, and accumulated surgical experience remain key determinants of optimal outcomes.