Outcome of laparoscopic splenectomy with preoperative splenic artery embolization for massive splenomegaly.

Background: Laparoscopic splenectomy (LS) has become a safe and feasible procedure for cases involving spleens of normal size. Only a few publications report on the outcome of LS with preoperative splenic artery embolization (SAE) for massive splenomegaly. The authors present their experience in patients with massive splenomegaly who underwent laparoscopic-assisted splenectomy (LAS) or hand-assisted laparoscopic splenectomy (HALS) following SAE.

Methods: A retrospective review of patients with massive splenomegaly undergoing LAS or HALS after preoperative SAE during the years 2004 to 2006 at the authors' institution was performed. Patients with a craniocaudal spleen length of 20 cm or greater were included in the study irrespective of their primary diagnosis. The data collected included information on patient demographics, operative details, rates of conversion to open procedures, perioperative blood transfusions, and postoperative complications. Routine Doppler ultrasound of the abdomen was performed on postoperative days 7 and 30 to screen for portal vein thrombosis (PVT).

Results: A total of 19 patients were identified. The median spleen length was 23 cm, and the median spleen weight was 1,740 g. Nine patients underwent LAS, and 10 underwent HALS. The median operative time was 130 min, and the median hospital stay was 6 days. There were no conversions to open laparotomy. The median estimated blood loss was 200 ml. One patient required reoperation 24 h after LAS due to bleeding, and PVT developed in three patients postoperatively.

Conclusions: In the setting of massive splenomegaly, LAS or HALS with preoperative SAE is safe and has a low conversion rate. Postoperative imaging surveillance for PVT should be performed routinely in this patient population.