title: Concomitant intraoperative splenic artery embolization and laparoscopic splenectomy versus laparoscopic splenectomy: comparison of treatment outcome.
abstract: BACKGROUND
  Although laparoscopic splenectomy has become the preferred treatment of choice for hematologic-related splenic disorders, intraoperative blood loss remains a common occurrence. In an effort to reduce this risk, we evaluate the potential role and clinical outcome of concomitant intraoperative splenic artery embolization and laparoscopic splenectomy.
  
  
  METHODS
  Between June 2000 and July 2005, 18 patients with hematologically related splenic disorders underwent combined intraoperative splenic artery embolization and laparoscopic splenectomy (group 1). For comparison, we studied 18 age- and gender-matched case controls undergoing same operations during the same period (group 2). Intraoperative data and clinical outcome were compared between the 2 groups.
  
  
  RESULTS
  Technical success was 100% in group 1. One patient in group 2 was converted to open splenectomy because of severe blood loss, resulting in a technical success rate of 95%. The mean splenic size in group 1 and group 2 was 15.5 +/- 4.7 cm (range, 12-23 cm) and 15.7 +/- 6.8 (range, 11-24 cm), respectively (not significant [NS]). Mean operative time in group 1 and group 2 was 175 minutes and 162 minutes, respectively (NS). Significantly less intraoperative blood loss was noted in group 1 (mean, 25 mL; range, 15-63 mL) compared with group 2 (mean, 240 mL; range, 150-420 mL; P < .003). There was an even greater difference in blood loss between the 2 groups when the splenic size was greater than 18 cm (mean 35 mL in group 1 versus 350 mL in group 2, P < .001). No differences were noted in postoperative recovery, return of bowel function, or length of hospital stay between the 2 groups.
  
  
  CONCLUSIONS
  Concomitant splenic artery embolization and laparoscopic splenic reduced operative blood loss when compared with laparoscopic splenectomy procedure alone. Splenic artery embolization is a useful intraoperative adjunctive procedure that should be considered in patients undergoing laparoscopic splenectomy for hematologic disorders who are Jehovah's Witness or with significant hypersplenism because of benefit of reduced blood loss.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine & Michael E. DeBakey VA Medical Center, Houston VAMC (112), 2002 Holcomb Blvd, Houston, TX 77030, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Naoum
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Silberfein
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: F Charles
authors.initials: FC
authors.lastname: Brunicardi
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.forename: Hosam F
authors.initials: HF
authors.lastname: El Sayed
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery; D013158:Splenic Diseases / Q000209:etiology / Q000628:therapy*; D013921:Thrombocytopenia / Q000150:complications; D016896:Treatment Outcome