Laparoscopic splenectomy 15 years after.

OBJECTIVE

The authors aim to analyze the impact of spleen size on the operative time, the splenic weight, the surgical technique, and the immediate clinical outcome in a series of 116 laparoscopic splenectomies (LS) performed in our department in the last 15 years. This study was also aimed to evaluate the efficacy of hand-assisted LS for splenomegaly.

MATERIALS AND METHODS

From July 1995 to January 2010, 116 LS were performed. In all the procedures, the 3- or 4-trocar lateral approach was used. The mean indication for surgery was hematologic diseases.

RESULTS

Of the 116 patients (69 females, mean age 41.7), the average weight of the spleens removed was about 450 g. The mean operative time was 100 minutes. Five patients underwent conversion. The mean duration of postoperative hospitalization was 4 days. No long-term complications were reported. Postoperative complications were reported in 3.5% of the cases.

CONCLUSIONS

The laparoscopic approach is safe and effective, with a shorter hospital stay and improved morbidity and mortality. LS may be considered as an acceptable indication even in cases of massive splenomegaly, and hand-assisted LS could be considered as a viable alternative to open surgery in patients with massive spleens.