title: Splenic hilum management during laparoscopic splenectomy.
abstract: BACKGROUND
  The division of the splenic hilum is the most delicate step during laparoscopic splenectomy. An incorrect approach could lead to a series of related complications. Aim of the study was to report authors' personal experience in a series of 107 laparoscopic splenectomies where the splenic hilum was approached by means of stapling device. A possible relationship between instruments used to divide the splenic artery and vein and complications was analyzed.
  
  
  METHODS
  Laparoscopic splenectomy was performed in 107 cases at authors' institution between 1998 and January 2011. In all the patients, splenic hilum was approached by means of vascular stapler.
  
  
  RESULTS
  Indications for the spleen removal mainly were hematologic disorders. Associated surgical procedures were performed in 32 cases. Among the 13 patients who required a conversion to open splenectomy, only in 3 cases the reason was related to the hilum management. Postoperative complications included portal vein thrombosis in 3 cases, pancreatic fistula in 1 case, and bleeding, requiring reintervention, in 2 cases.
  
  
  CONCLUSIONS
  The use of the stapling device is a safe and effective method to approach the splenic hilum during laparoscopic splenectomy. In experienced hands it showed a low rate of related complications.
authors.affiliation: Department of Surgery, Laparoscopic Surgery Unit, University of Catania, Policlinico Vittorio Emanuele Hospital, Catania, Italy. rvecchio@unict.it
authors.forename: Rosario
authors.initials: R
authors.lastname: Vecchio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Marchese
authors.forename: Ehab
authors.initials: E
authors.lastname: Swehli
authors.forename: Eva
authors.initials: E
authors.lastname: Intagliata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*; D017792:Surgical Stapling; D055815:Young Adult