Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Jul;228(1):35–39. doi: 10.1097/00000658-199807000-00006

Splenomegaly should not be considered a contraindication for laparoscopic splenectomy.

E M Targarona 1, J J Espert 1, C Balagué 1, J Piulachs 1, V Artigas 1, M Trias 1
PMCID: PMC1191425  PMID: 9671064

Abstract

OBJECTIVE: To analyze the impact of spleen size on operative and immediate clinical outcome in a series of 74 laparoscopic splenectomies (LS). SUMMARY BACKGROUND DATA: LS is gaining acceptance as an alternative to open splenectomy. However, splenomegaly hinders LS, and massive splenomegaly has been considered a contraindication. METHODS: Between February 1993 and September 1997, 74 patients with a wide range of splenic disorders were treated by laparoscopy and prospectively recorded. They were classified into three groups according to spleen weight: group I, <400 g (n = 52); group II, 400 to 1000 g (n = 9); and group III, >1000 g (n = 13). Age, operative time, number of trocars required, need for perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia requirements, length of hospital stay, and morbidity rates were recorded. RESULTS: LS was completed in 69 patients, and the conversion rate was thus 6.7%. Operative time was significantly longer in patients with larger spleens, and an accessory incision was more frequently required. However, there were no significant differences in transfusion rate, length of stay, severe morbidity, or conversion rate. CONCLUSIONS: Preliminary evaluation of LS for patients with large spleens suggests that it requires a longer operative time, but it is feasible and may potentially offer the same advantages (shorter stay and faster recovery) as it does to those with smaller spleens.

Full text

PDF
37

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aksnes J., Abdelnoor M., Mathisen O. Risk factors associated with mortality and morbidity after elective splenectomy. Eur J Surg. 1995 Apr;161(4):253–258. [PubMed] [Google Scholar]
  2. Bickerstaff K. I., Morris P. J. Splenectomy for massive splenomegaly. Br J Surg. 1987 May;74(5):346–349. doi: 10.1002/bjs.1800740505. [DOI] [PubMed] [Google Scholar]
  3. Coon W. W. Splenectomy for massive splenomegaly. Surg Gynecol Obstet. 1989 Sep;169(3):235–237. [PubMed] [Google Scholar]
  4. Danforth D. N., Jr, Fraker D. L. Splenectomy for the massively enlarged spleen. Am Surg. 1991 Feb;57(2):108–113. [PubMed] [Google Scholar]
  5. Farid H., O'Connell T. X. Surgical management of massive splenomegaly. Am Surg. 1996 Oct;62(10):803–805. [PubMed] [Google Scholar]
  6. Friedman R. L., Fallas M. J., Carroll B. J., Hiatt J. R., Phillips E. H. Laparoscopic splenectomy for ITP. The gold standard. Surg Endosc. 1996 Oct;10(10):991–995. doi: 10.1007/s004649900221. [DOI] [PubMed] [Google Scholar]
  7. Grossbard M. L. Is laparoscopic splenectomy appropriate for the management of hematologic and oncologic diseases? Surg Endosc. 1996 Apr;10(4):387–388. doi: 10.1007/BF00191620. [DOI] [PubMed] [Google Scholar]
  8. Hiatt J. R., Gomes A. S., Machleder H. I. Massive splenomegaly. Superior results with a combined endovascular and operative approach. Arch Surg. 1990 Oct;125(10):1363–1367. doi: 10.1001/archsurg.1990.01410220147021. [DOI] [PubMed] [Google Scholar]
  9. Horowitz J., Smith J. L., Weber T. K., Rodriguez-Bigas M. A., Petrelli N. J. Postoperative complications after splenectomy for hematologic malignancies. Ann Surg. 1996 Mar;223(3):290–296. doi: 10.1097/00000658-199603000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Johnson H. A., Deterling R. A. Massive splenomegaly. Surg Gynecol Obstet. 1989 Feb;168(2):131–137. [PubMed] [Google Scholar]
  11. Katkhouda N., Waldrep D. J., Feinstein D., Soliman H., Stain S. C., Ortega A. E., Mouiel J. Unresolved issues in laparoscopic splenectomy. Am J Surg. 1996 Nov;172(5):585–590. doi: 10.1016/S0002-9610(96)00243-7. [DOI] [PubMed] [Google Scholar]
  12. Lacy A. M., García-Valdecasas J. C., Piqué J. M., Delgado S., Campo E., Bordas J. M., Taurá P., Grande L., Fuster J., Pacheco J. L. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc. 1995 Oct;9(10):1101–1105. doi: 10.1007/BF00188996. [DOI] [PubMed] [Google Scholar]
  13. Letoquart J. P., La Gamma A., Kunin N., Grosbois B., Mambrini A., Leblay R. Splenectomy for splenomegaly exceeding 1000 grams: analysis of 47 patients. Br J Surg. 1993 Mar;80(3):334–335. doi: 10.1002/bjs.1800800322. [DOI] [PubMed] [Google Scholar]
  14. MacRae H. M., Yakimets W. W., Reynolds T. Perioperative complications of splenectomy for hematologic disease. Can J Surg. 1992 Aug;35(4):432–436. [PubMed] [Google Scholar]
  15. Park A., Gagner M., Pomp A. The lateral approach to laparoscopic splenectomy. Am J Surg. 1997 Feb;173(2):126–130. doi: 10.1016/S0002-9610(97)89602-X. [DOI] [PubMed] [Google Scholar]
  16. Poulin E. C., Thibault C. Laparoscopic splenectomy for massive splenomegaly: operative technique and case report. Can J Surg. 1995 Feb;38(1):69–72. [PubMed] [Google Scholar]
  17. Targarona E. M., Espert J. J., Balagué C., Sugrañes G., Ayuso C., Lomeña F., Bosch F., Trias M. Residual splenic function after laparoscopic splenectomy: a clinical concern. Arch Surg. 1998 Jan;133(1):56–60. doi: 10.1001/archsurg.133.1.56. [DOI] [PubMed] [Google Scholar]
  18. Trias M., Targarona E. M., Balagué C. Laparoscopic splenectomy: an evolving technique. A comparison between anterior and lateral approaches. Surg Endosc. 1996 Apr;10(4):389–392. doi: 10.1007/BF00191621. [DOI] [PubMed] [Google Scholar]
  19. Trías M., Targarona E. M. Laparoscopic treatment of hereditary spherocytosis (splenectomy plus cholecystectomy). J Laparoendosc Surg. 1994 Feb;4(1):71–73. doi: 10.1089/lps.1994.4.71. [DOI] [PubMed] [Google Scholar]
  20. Wobbes T., van der Sluis R. F., Lubbers E. J. Removal of the massive spleen: a surgical risk? Am J Surg. 1984 Jun;147(6):800–802. doi: 10.1016/0002-9610(84)90205-8. [DOI] [PubMed] [Google Scholar]
  21. Yee J. C., Akpata M. O. Laparoscopic splenectomy for congenital spherocytosis with splenomegaly: a case report. Can J Surg. 1995 Feb;38(1):73–76. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES