Surgical management of massive splenomegaly

Recent reports document an increased mortality and morbidity associated with splenectomy for massive splenomegaly (<1000 g), with a morbidity that is 2 to 10-fold higher than that seen for splenectomy for normal size spleens. Preoperative angiographic embolization of the splenic artery has been advocated as a means to decrease this morbidity and mortality. In a retrospective review of 100 splenectomies performed at Kaiser Permanente (Los Angeles, CA), 20 were performed for splenomegaly, average weight 1811 g (1050-3700 g), and 80 were normal sized spleens. Mortality for normal sized spleens is 1.25 per cent, and for those performed for splenomegaly is zero. Likewise, the morbidity for splenectomy of normal sized spleens was 21.25 per cent, but for splenomegaly, a 20 per cent morbidity rate was observed. Average blood loss with splenomegaly was 696 mL, slightly higher than the 600 mL blood loss for normal sized spleens. Sixty-seven per cent of patients with splenomegaly required no transfusion, and none required more than two units. Of patients with normal size spleens, 75 per cent required no transfusion, and 96 per cent required two units or less. Splenectomy for splenomegaly is possible without an increase in morbidity or mortality. In this series, preoperative embolization was not performed; however, the morbidity and mortality rates compare favorably with series in which it was performed. Preoperative embolization of the splenic artery may be unnecessary and may expose the patient to additional expense, risk, and discomfort.