Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy.
OBJECTIVE
To evaluate the impact of spleen weight on operative and clinical outcome in a series of 108 consecutive laparoscopic splenectomies.


BACKGROUND
Laparoscopic splenectomy as an alternative to open splenectomy for splenomegaly is regarded as controversial.


METHODS
Patients underwent laparoscopic splenectomy for a range of hematological disorders between November 1992 and February 2000. Multiple linear and logistic regression analysis were used to assess the effect of massive splenomegaly (>1000 g) on perioperative mortality and morbidity, after adjusting for the joint effects of patient age, weight, pre- and postoperative full blood counts, operating time, estimated blood loss, conversion rate, reoperation rate, and duration of hospital stay.


RESULTS
Massive splenomegaly was recorded in 27 of 108 (25%) cases. In this group, splenic weight ranged from 1000 to 4750 g (median, 2500 g). Patients with splenic weight >1000 g had a significantly longer median operating time (170 vs. 102 minutes, P < 0.01), conversion rate (5/27 vs. 4/81, P < 0.05), postoperative morbidity (15/27 vs. 4/81, P < 0.01), and median postoperative stay (5 vs. 3 days, P < 0.01). Multivariate analysis found splenic weight to be the most powerful predictor of morbidity (P < 0.01). Patients with splenomegaly (>1000 g) were 14 times likely to have post operative complications. One patient died 3 days after surgery, following a pulmonary embolus (spleen weight 500 g, mortality 1/108, 0.9%).


CONCLUSIONS
Laparoscopic splenectomy is feasible in patients with giant spleens. However, it is associated with greater morbidity, and the advantages of minimal access surgery in this subgroup of patients are not so clear.
Patel
Ameet G
AG
Departments of Surgery, Haematology, and Biostatistics, King's College Hospital, London, United Kingdom.agp@ameet.dircon.co.uk
Parker
Jane E
JE
Wallwork
Ben
B
Kau
Keith B
KB
Donaldson
Nora
N
Rhodes
Michael R
MR
O'Rourke
Nicholas
N
Nathanson
Les
L
Fielding
George
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D013163:Splenomegaly / Q000473:pathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D006113:United Kingdom / Q000453:epidemiology