Splenomegaly as A Complication Factor in Laparoscopic Splenectomy: Outcomes from 100 Cases by A Single Surgeon

Abstract 

1. Introduction: Laparoscopic Splenectomy (LS) is believed to be the gold standard in spleen surgery and is considered to be relatively safe with minimal complications, depending on the technology at hand, and the experience of the surgeon. 
2. Methods: This paper presents data from 100 LS procedures under a single general surgeon over the last 17 years performed in a regional hospital. 
3. Results: Of these 100 patients, female to male ratio was 1.5: 1. Median age was 57.5 (15- 91) years. Most common indications for splenectomy were Benign Haematological Diseases (BHD), Group 1: (88%) largely idiopathic thrombocytopenic purpura (66); Group 2 had Malignant Haematological Disease (MHD) (7%); Group 3 sarcoidosis (5%). The average operation time was 107 (30-210) min. Splenunculi were found during LS in 4%. Only one LS was converted to open. Mean weight of spleen was 237 grams. There were seven cases of moderate splenomegaly (weight >/= 500g). There were significant differences between the three groups in spleen weights (p<0.0001) and this appeared to be linked with certain complications. Early complications were haemorrhage from the short gastric artery (2%), pneumonia, upper gastrointestinal haemorrhage and portal vein thrombosis. The MHD group had more severe complications than the BHD group. The average LOS was 3.28 days. 
4. Conclusions: We found that large spleens were related to severe complications. Our results were comparable with the literature, although the rate of complications in our study was lower. The latter could be due to the fact that we did not have any cases of supramassive splenomegaly.