Massive Splenomegaly Is Associated With Significant Morbidity After Laparoscopic Splenectomy

Abstract

Laparoscopic splenectomy is feasible in patients with giant spleens. However, it is associated with greater morbidity, and the advantages of minimal access surgery in this subgroup of patients are not so clear.

Platelet Transfusion Improves Liver Function in Patients with Chronic Liver Disease and Cirrhosis

“…Splenectomy and partial splenic embolization induce thrombocytosis and improve liver function for more than 6 months in patients with CLD and cirrhosis (Murata et al 1996;Murata et al 2008a). However, patients with CLD and cirrhosis often have splenomegaly and thrombocytopenia and are at high risk for bleeding and complications in operations (Patel et al 2003;Ohta et al 2005). Additionally, partial splenic embolization has various complications, such as ascites, splenic or portal vein thrombosis, splenic abscess, and splenic necrosis.…”

Optimizing the technique of laparoscopic splenectomy in children

“…In Winslow's meta-analysis haemorrhage was described in 4.8% of patients, including the need for conversion for intraoperative bleeding and 1.6% if conversions were excluded [30]. Other authors mentioned above report a hemorrhagic complication rate of 0 to 5.5% [8,12,16,17,22,29,33,34]. In our group two patients (2.59%) needed conversion to open procedure.…”

“…Literature data are contradictory and many do not consider abdominal incision a conversion whenever oncological guidelines require removal of the spleen in one piece [14,17,36]. Patel considered the procedure minimally invasive when the skin incision did not exceed 5 cm [34]. The authors agree that the number of conversions decreases with experience of the surgeon, and together with duration of surgery is a criterion of learning curve assessment [17,34,33].…”

“…When hospitalization lasted longer than 4 days, it resulted from intra-or post-operative complications, which are described below. The most important factor allowing for assessment of the adopted surgical technique is the rate of peri-operative complications and conversion rate in laparoscopic procedures [31][32][33][34][35][36]. We have studied the number of adverse events.…”

Surgery for massive splenomegaly

“…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’.…”