Effect of spleen size on splenectomy outcome

Abstract

In patients with enlarged spleens, LS is feasible and followed by lower morbidity, transfusion rate, and shorter hospital stay than when the open approach is used. For the treatment of this subset of patients, who usually present with more severe hematologic diseases related to greater morbidity, LS presents potential advantages.

Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

“…Amongst the 58 patients operated on laparoscopically for ITP, there were three accessory spleens diagnosed preoperatively and intraoperatively; three others were noted intraoperatively only, and one was spotted postoperatively. Therefore, the incidence of accessory spleens reached 12.1% and was slightly lower than in the cited references [7,11,18,19,26].…”

“…Although some authors suggest that the most commonly used method of operation, known as the "hanging spleen" technique, makes the approach to the sites with higher frequencies of accessory spleens more difficult [25], the opinion that the approach to the most essential topographical sites is sufficient is in favour. Those locations are: hylus and poles of the spleen, omental sac, pancreatic tail and gastro-splenic ligament [18,21,26]. In the cases described we did not have a problem with identifying the changes revealed preoperatively-they were excised as well as the three diagnosed during laparoscopic examination.…”

Laparoscopic Splenectomy with Technical Standardization and Selection Criteria for Standard or Hand-Assisted Approach in 390 Patients with Liver Cirrhosis and Portal Hypertension

“…However, LS is occasionally converted to open splenectomy, and the conversion is often due to massive intraoperative bleeding 11,12 . Especially in patients with massive splenomegaly, LS becomes technically challenging, because of limited abdominal working space and difficult intra-abdominal manipulation of large spleens [13][14][15][16] splenomegaly 10 . The EAES guidelines also suggest that portal hypertension from liver cirrhosis should be considered a contraindication of LS.…”

Surgery for massive splenomegaly

“…Laparotomy is usually required to remove a massive spleen. Pioneers of laparoscopic splenectomy11, 12 concluded that spleens weighing more than 3·2 kg required conversion to open surgery. Others22, 23 have suggested a limitation of a splenic size greater than 27 or 30 cm.…”

“…Observational studies1, 2, 3, 4, 5, 6, 7, 8 have reported mortality rates of 1·8–15 per cent and complication rates of 9–51 per cent. Numerous case reports and small series9, 10, 11, 12, 13, 14, 15, 16 have shown the feasibility of laparoscopic splenectomy for massive splenomegaly, but, as with open splenectomy, the criterion of a spleen weight greater than 1·5 kg has not been used consistently to refer to massive splenomegaly3, 17, 18. Some reports9 regarding the safety of laparoscopic approaches have included splenic specimens of only 500 g, whereas others10, 11, 12, 13 have included spleens of more than 600 or 1000 g. Other authors14, 15, 16 have categorized spleens weighing 600–1600 g as ‘massive’, and those weighing more than 1600 g as ‘supramassive’.…”