Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases

Abstract

Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications.

Pancreatic Fistula and Biochemical Leak after Splenectomy: Incidence and Risk Factors—A Retrospective Single-Center Analysis

“…Splenectomies are often viewed as learning procedures [ 34 ]. The data presented here further reminds the surgical community that these procedures pose a significant risk for the development of POPF and experienced (pancreatic) surgeons should be present, especially in the case of a difficult situs [ 30 , 39 , 49 , 50 ]. It is also reasonable to advocate that patients with a certain risk profile needing a PSE or patients with an expected SSE should be presented at a center with expertize not only in splenic surgery but also in pancreatic surgery, to avoid failure to rescue in cases with complicated postoperative courses due to POPF [ 50 ].…”

“…Indications for PSE often include splenomegaly and the size of the spleen has been suggested to be a risk factor for the development of POPF [ 29 , 30 ]. In addition, Targarona et al identified splenic weight as a risk factor for postoperative complications [ 31 ].…”

Laparoscopic splenectomy and devascularization for massive splenomegaly in portal hypertensive patients: a retrospective study of a single surgical team’s experience with 6-year follow-up data

“…Intraoperative abdominal bleeding is a major cause of conversion to open surgery. It has been reported that a spleen length ≥19 cm is a risk factor for difficult LS and intraoperative hemorrhage (24). No significant difference in HVPG was found between the 2 groups; however, the diameters of the splenic and portal veins in the MS group were much larger than those of the MMS group, indicating that more portal-systemic collaterals formed in the MS group.…”

Elective splenectomy in patients with non-Hodgkin lymphoma: Does the size of the spleen affect surgical outcomes?

“…In all three cases, the intraoperative bleeding was secondary to difficult access to the splenic hilum and inadequate vascular control. The correlation between large spleen size and increased risk of intraoperative bleeding during splenectomy has been reported in the published literature [ 24 - 25 ].…”