title: Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy.
abstract: OBJECTIVE
  Laparoscopic splenectomy is occasionally converted to open surgery due to massive intraoperative bleeding. The aim of this study was to identify the risk factors for massive bleeding during laparoscopic splenectomy.
  
  
  METHODS
  Fifty-three patients underwent laparoscopic splenectomy. The indications were hematologic disease in 25 patients, liver cirrhosis in 17 patients, and other conditions in 11 patients. Univariate analysis was conducted with Fisher's exact test, and multivariate analysis was conducted with a stepwise logistic regression model.
  
  
  RESULTS
  None of the patients required open surgery. Blood loss of more than 800 ml was defined as massive intraoperative bleeding. Univariate analysis showed significant risk factors for massive bleeding to be liver cirrhosis, portal hypertension, splenomegaly, Child class, and preoperative platelet count. Independent risk factors in the multivariate analysis were portal hypertension and Child class.
  
  
  CONCLUSIONS
  Careful attention to intraoperative bleeding during laparoscopic splenectomy is necessary for patients with portal hypertension and/or deteriorated liver function.
authors.affiliation: First Department of Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohta
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishizaki
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Rinshyun
authors.initials: R
authors.lastname: Shimabukuro
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sasaki
authors.forename: Kohei
authors.initials: K
authors.lastname: Shibata
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Matsusaka
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D013163:Splenomegaly