title: Laparoscopic splenectomy: a surgeon's experience of 302 patients with analysis of postoperative complications.
abstract: BACKGROUND
  This study aimed to evaluate the operative and clinical outcomes in a series of 302 consecutive laparoscopic splenectomies and to analyze the risk factors of postoperative complications.
  
  
  METHODS
  The study retrospectively reviewed 302 consecutive patients who underwent laparoscopic splenectomy. The patients were classified into three disease groups: benign spleen-related disease (group 1, n = 196), malignant spleen-related disease (group 2, n = 42), and portal hypertension (group 3, n = 64). The three groups were compared in terms of perioperative data. Postoperative complications were classified into three complication groups according to the Clavien-Dindo Classification of Surgical Complications and Severity: no complication, mild complications, and severe complications. Multivariate logistic regression was used to analyze the independent risk factors of postoperative complications.
  
  
  RESULTS
  The patients in group 1 were younger and had a higher body mass index, a lower American Society of Anesthesiology (ASA) score, and a smaller spleen than the patients in groups 2 and 3. Fewer patients in group 1 required hand-port assistance than in the other two groups. Group 1 had shorter operative times, required fewer transfusions, presented a lower incidence of complications, and had shorter postoperative stays than groups 2 and 3. In the analysis of complications, high ASA score was an independent risk factor for the occurrence of complications. Both high ASA score and larger spleen size were independent risk factors for the occurrence of severe complications. Compared with total laparoscopic splenectomy, the data including the hand-assisted cases showed a reduction in odds ratio for both the occurrence of complications and the occurrence of severe complications.
  
  
  CONCLUSIONS
  The treatment of malignant spleen-related disease and portal hypertension with laparoscopic splenectomy is more challenging than the treatment of benign disease. High ASA score is an independent risk factor for the occurrence of complications, whereas high ASA score and larger spleen size are both independent risk factors for the occurrence of severe complications. The appropriate introduction of the hand-assisted technique may facilitate the laparoscopic procedure and reduce postoperative complications.
authors: Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors: Xin
authors: X
authors: Wang
authors: Yongbin
authors: Y
authors: Li
authors: Nicolas
authors: N
authors: Crook
authors: Bing
authors: B
authors: Peng
authors: Ting
authors: T
authors: Niu
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002681:China / Q000453:epidemiology; D003953:Diagnosis-Related Groups; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D013158:Splenic Diseases / Q000601:surgery; D013160:Splenic Neoplasms / Q000601:surgery; D013163:Splenomegaly / Q000601:surgery; D016896:Treatment Outcome
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