Laparoscopic splenectomy for benign and malignant splenic diseases in consideration to splenomegaly:what's the difference?

Introduction: Laparoscopic splenectomy (LS) is the preferred choice for elective removal of normal and moderate sized spleens, but in the patients with spleen malignancies and with massive splenomegaly (MS) is still controversial. The aim of this prospective study was to analyse and compare the safety and efficacy of LS for benign and malignant splenic disease in the settings of the spleen enlargement. Methods: In the past 5 years operative and postoperative data were prospectively collected in 23 patients submitted to LS due to benign (15) and malignant (8) splenic disease. Results: There were no differences in the mean age between malignant and benign group. Mean spleen size in both groups was 19, 6 cm (range 11-28 cm) and total conversion rate 8, 6% (2 malignant group patients). Mean operative time in malignant group was not statistically longer (163, 8 ±43, 3 min vs 143, 3 ±28, 9 min, p = 0.1878) as well as the need for accessory incision for spleen retrieval (3 of 8 vs 2 of 15 patients, p = 0, 2076). Eight (35%) patients required intraoperative blood transfusion, 3 (37%) in malignant and 5 (33%) in benign group, with more blood replacement in benign group (428, 67 ml vs. 157, 5 ml, p = 0, 305). Estimated blood loss was significantly higher in this group (252 98 ml vs 151, 3 ml, p = 0.023) due to low platelet count. The length of hospital stay was the same for both groups. In MS (diameter > 20cm) operativetime was significantly longer (165, 45 ±34, 67 min vs 136, 67 ± 30, 56 min, p = 0, 0464). There were no differences between MS and moderate splenomegaly in requiring blood transfusion, blood replacement (425, 56 - 695, 11 ml vs. 428, 89 - 621, 72 ml, p = 0, 9904) and the length of hospital stay. Only one laparoscopic reoperation due to bleeding was performed. Conclusion: LS offers major clinical advantages but requires great technical care particularly in patients with malignant splenic disease and massive splenomegaly. It seems that there are no significant differences in operative time, need for accessory incision and the length of hospital stay as well as complication rate whether LS is preformed for benign or malignant disease.