Can we predict immediate outcome after laparoscopic splenectomy for splenomegaly? Multivariate analysis of clinical, anatomic, and pathologic features after 3D reconstruction of the spleen.

The laparoscopic approach is the treatment of choice for splenectomy, but its definitive role in splenomegaly is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathological. The aim of this study was to evaluate the predictive factors on outcome after laparoscopic splenectomy in splenomegaly. We reviewed patients submitted to laparoscopic splenectomy with a final spleen weight superior to 700 g. Three-dimensional reconstruction of the spleen was performed, and spleen volume and diameters were measured. Multivariate analysis showed that factors that predicted for conversion were mediolateral diameter ( P = .039, RR: 1.43) and platelet count (P < .05, RR: 1). For intraoperative bleeding, the predictive factor was spleen volume (P < .03, RR: 1.003). Anteroposterior spleen diameter was related to operative time (P = .011), and the factor related to postoperative morbidity was age (P = .049, RR: 0.941). Local anatomy and clinical factors affect surgical outcome in laparoscopic splenectomy for splenomegaly. These factors should be taken into account when planning this kind of procedure.