Laparoscopic splenectomy in patients with splenomegaly-tendency or contraindication?

Aim: Laparoscopic splenectomy presents a challenge in patients with splenomegaly despite being the preferred procedure for most elective splenectomies. Our experience with laparoscopic splenectomy in the setting of splenomegaly is presented. Methods: The data were collected prospectively from May 2003. to October 2011. in 39 patients that underwent LS in Clinical Hospital “Dubrava” Zagreb, Croatia. The nature of disease, spleen size (measured on CT or ultrasound), gender, age, op time, conversion, hospital stay, need for accessory incision, type of splenic artery ligation preoperative and postoperative platelet values were recorded. The impact of diagnosis (benign/malignant) and the spleen size onto the outcome following LS in seven years period were evaluated. Results: Majority of patients submitted to LS had benign hematologic disease (30 of 39) and more than half of them had splenomegaly (23/39). Majority of patients with splenic malignancy have splenomegaly (8 of 9). The mean spleen size in splenomegaly patients was 23, 88 cm (range 15-31 cm). Splenomegaly was associated with higher conversion rate (3 vs 2) due to bleeding and longer mean operative time (128, 54 vs 104, 75 min). Furthermore, in splenomegaly more patients required accessory incision and additional port (7 vs 1) and blood transfusion (8 vs 1). But length of stay and postoperative morbidity was not associated with enlarged spleen in our series. Conclusion: According to our results, the same as to some previously presented studies LS has become a treatment of choice for majority of patients including those with splenomegaly. In spite of longer operative time and more blood loss laparoscopic splenectomy in the setting of splenomegaly is safe in appropriately experienced hands with full awareness of increased complexity of technical performance and caution requirement.