title: Laparoscopic splenectomy: outcome and efficacy for massive and supramassive spleens.
abstract: BACKGROUND
  Massive and supramassive splenomegaly are relative contraindications to pure laparoscopic splenectomy (LS).
  
  
  METHODS
  A retrospective review of adult patients was conducted for splenectomy occurring from 1999 to 2009. Massive and supramassive spleens were defined as craniocaudad length ≥ 17 cm or weight ≥ 600 g and craniocaudad length ≥ 22 cm or weight ≥ 1,600 g, respectively.
  
  
  RESULTS
  LS was done for 22 and open splenectomy for 21 patients, of which 12 and 14 were supramassive. Spleen weight and craniocaudad length were comparable. LS was associated with lower blood loss (308 vs 400 mL, P = .24), shorter length of stay (3 vs 4.5 days, P = .054), and similar morbidity (17% vs 14%). Two reoperations and 1 death occurred with open splenectomy. Operative times were longer for LS (195 vs 105 min, P = .008), while the conversion rate was 25%.
  
  
  CONCLUSIONS
  In cases of massive and supramassive splenomegaly, better outcomes are accomplished with LS than open splenectomy, and are comparable to hand-assisted LS.
authors.affiliation: Department of Surgery, Morristown Memorial Hospital-Atlantic Health, Morristown, NJ, USA. vadimkoshenkov@yahoo.com
authors.forename: Vadim P
authors.initials: VP
authors.lastname: Koshenkov
authors.forename: Zoltán H
authors.initials: ZH
authors.lastname: Németh
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013163:Splenomegaly / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome