title: Primary versus secondary splenic pedicle dissection in laparoscopic splenectomy for splenic diseases.
abstract: BACKGROUND
  Some areas of laparoscopic splenectomy (LS), such as the approach to splenic pedicle dissection, remain controversial. Here we recommend a technique for dissecting the secondary splenic pedicle vessels on the basis of analysis of retrospective data.
  
  
  METHODS
  A retrospective review (April 2006 to October 2011) of databases at 2 institutions identified 136 patients who had undergone LS. In 34 patients with massive splenomegaly, primary splenic pedicle dissection technique (PSPD) had been used in 19 patients and secondary splenic pedicle dissection technique (SSPD) had been used in 15 patients. In 102 patients with normal-sized spleen or moderate splenomegaly, PSPD had been used in 56 patients and SSPD in 46 patients. We compared perioperative and follow-up data.
  
  
  RESULTS
  Laparoscopic splenectomy was completed in 128 patients. In the massive splenomegaly group, the conversion rate was 5.3% for PSPD and 33.3% for SSPD, the complication rate was 42.1% vs 20%, hospital stay was 3.2 ± 2.0 days vs 7.5 ± 3.5 days, and transfusion requirement was 1.1 ± 1.2 U vs 3.2 ± 0.9 U, respectively. However, in the normal or moderate splenomegaly group, except for complications, there were no significant differences between PSPD and SSPD techniques in perioperative findings. In the 2 groups, there were significant differences between the PSPD and SSPD techniques in pancreatic leakage (15.8% vs 0 and 8.9% vs 0, respectively) and postoperative fever (15.8% vs 6.7% and 10.7% vs 2.2%, respectively).
  
  
  CONCLUSIONS
  Secondary splenic pedicle dissection can decrease the incidence of splenic fever and pancreatic leakage and is a valuable technique for LS for normal-sized spleen or moderate splenomegaly. It is not a safe procedure for massive splenomegaly because of the high conversion rate.
authors.affiliation: Department of General Surgery, Jinhua People's Hospital, Jinhua, China.
authors.forename: Qiuliang
authors.initials: Q
authors.lastname: Yan
authors.forename: Jinhui
authors.initials: J
authors.lastname: Zhu
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Zhan
authors.forename: Weihong
authors.initials: W
authors.lastname: Weng
authors.forename: Wanbo
authors.initials: W
authors.lastname: Wu
authors.forename: Dijian
authors.initials: D
authors.lastname: Shen
authors.forename: Kai
authors.initials: K
authors.lastname: Yu
authors.forename: Yuedong
authors.initials: Y
authors.lastname: Wang
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*; D013163:Splenomegaly / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome