LAPAROSCOPIC SPLENECTOMY FOR MASSIVE SPLENOMEGALY - OPERATIVE TECHNIQUE AND CASE-REPORT

Although laparoscopic splenectomy is the preferred technique for the e lective removal of normal-sized and moderately enlarged spleens, its v alue in the management of massive splenomegaly has not been defined. A 33-year-old woman with massive splenomegaly was managed by laparoscop ic splenectomy. The splenic vessels were embolized preoperatively to r educe operative blood loss. Laparoscopic surgery involved dissection o f the suspensory ligaments at the lower pole of the spleen followed by dissection and ligation of all splenic branches near the splenic pare nchyma. The operative field was explored manually through a 10-cm long Pfannenstiel incision at the pubic hairline, and under videoscopic co ntrol the remaining structures were safely secured. The spleen was del ivered into the pelvis, fragmented and removed in large pieces. The in cisions were closed after proper irrigation and laparoscopic inspectio n of the operative field. Further clinical evaluation is required to d etermine if the procedure is more efficacious than the open technique for massive splenomegaly.