title: Laparoscopic splenectomy for massive splenomegaly.
abstract: BACKGROUND
  Laparoscopic splenectomy (LS) is the preferred operative approach for diseases involving normal-sized spleens. Our experience with laparoscopic splenectomy in the setting of massive splenomegaly is presented.
  
  
  METHODS
  A prospective review of patients undergoing LS for massive splenomegaly was conducted. Massive splenomegaly (MS) in adults was defined as a craniocaudal length >or=17 cm or a morcellated weight >or=600 g. In children, spleens measuring fourfold larger than normal for age were considered massive.
  
  
  RESULTS
  Forty-nine patients with MS were treated with LS. The most common primary diagnoses were lymphoma and leukemia. Mean splenic length was 20 cm (15 to 27 cm), with weights ranging from 600 to 4,750 g. Twelve patients with supermassive splenomegaly (length >22 cm) required a hand-assisted laparoscopic approach. There were no conversions to open surgery. Mean operating time was 171 minutes (90 to 369). Mean blood loss was 114 cc (<30 to 600 cc). Average length of stay was 2.3 days (1 to 16). Minor postoperative complications occurred in 3 patients.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy in the setting of splenomegaly is safe and appears to minimize perioperative morbidity. In patients with supermassive splenomegaly, a hand-assisted laparoscopic approach may be required.
authors.affiliation: Department of General Surgery, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232, USA.
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
authors.forename: Charles L
authors.initials: CL
authors.lastname: Backus
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome