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Splenic artery embolization before laparoscopic splenectomy. An update

E C Poulin1, J Mamazza, C M Schlachta

  • 1Department of Surgery, The Wellesley Central Hospital, University of Toronto, 160 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1J3.

Surgical Endoscopy
|June 5, 1998
PubMed
Summary
This summary is machine-generated.

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Preoperative splenic artery embolization is not necessary for small spleens (<20 cm) undergoing laparoscopic splenectomy. Improved surgical techniques and experience have reduced conversion rates without embolization.

Area of Science:

  • Surgical Oncology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Laparoscopic splenectomy is a common procedure for various splenic conditions.
  • Preoperative splenic artery embolization (SAE) has been considered to reduce bleeding and operative time.
  • The necessity and efficacy of SAE in laparoscopic splenectomy remain debated, particularly concerning spleen size.

Purpose of the Study:

  • To assess the role and necessity of preoperative splenic artery embolization (SAE) in laparoscopic splenectomy.
  • To compare outcomes between patients who underwent SAE and those who did not, stratified by spleen size.
  • To evaluate the impact of surgical approach (anterior vs. lateral) on outcomes.

Main Methods:

  • Retrospective analysis of 54 patients undergoing laparoscopic splenectomy between 1992 and 1994.

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  • Patients were divided into two groups: Group I (1992-1994) with SAE for spleens <20 cm and anterior approach; Group II (post-1994) without SAE for spleens <20 cm and lateral approach.
  • All patients with spleens >20 cm underwent SAE.

    • Main Results:

    • Five complications occurred, three related to embolic material.
    • For spleens <20 cm, Group I (SAE, anterior approach) had a lower conversion rate than most current series.
    • For spleens <20 cm, Group II (no SAE, lateral approach) achieved similar results due to increased experience and improved surgical approach.
    • For spleens 20-30 cm, SAE was used, with a higher conversion rate (17%) and frequent blood replacement (83%).
    • For spleens >30 cm, SAE did not prevent 100% conversion.

    Conclusions:

    • Preoperative SAE is not necessary for laparoscopic splenectomy in patients with spleens <20 cm.
    • Increased surgical experience and the lateral approach have led to shorter operations and low conversion rates, negating the need for SAE in smaller spleens.
    • SAE remains relevant for spleens measuring 20-30 cm, though associated with higher complication and blood transfusion rates.
    • Laparoscopic splenectomy for spleens >30 cm is currently not feasible with acceptable outcomes, even with SAE.