Laparoscopic splenectomy: size matters.
BACKGROUND
Laparoscopic surgery is arguably the treatment of choice for patients undergoing elective splenectomy; however, for those patients with massive splenomegaly, laparoscopic surgery may prove difficult.


METHODS
6 years' experience of elective splenectomy was reviewed, in particular looking at the outcome of laparoscopic splenectomy in relation to the degree of splenomegaly.


RESULTS
The conversion rate for laparoscopic splenectomy on patients with spleens weighing less than 1 kg was 0% whereas the conversion rate for those with spleens weighing more than 1 kg was 60%. In addition, a good correlation between both operative time and intra-operative blood loss in relation to splenic weight was observed. Open splenectomy on patients with spleens weighing more than 1 kg reduced the operative time and intra-operative blood loss without affecting hospital stay.


CONCLUSIONS
Laparoscopic splenectomy is the method of choice for elective splenectomy in patients with splenic weight estimated to be < 1 kg; however, the operation takes longer, there is a high risk of conversion and there is an increase in blood loss/morbidity associated with massive splenomegaly (spleen > 1 kg) if splenectomy is attempted laparoscopically.
Mahon
David
D
Upper Gastrointestinal/Hepatobiliary Unit, Department of Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
Rhodes
Michael
M
D016063:Blood Loss, Surgical; D017558:Elective Surgical Procedures; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*; D016896:Treatment Outcome