SPLENECTOMY FOR SPLENOMEGALY EXCEEDING 10 00 G - RETROSPECTIVE STUDY OF 36 PATIENTS

Splenectomy for massive splenomegaly is frequently performed for hemat ologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospec tive study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with spl enectomy weighing 1000 g or more, underwent splenectomy at Centre Hosp italier Universitaire Lyon Sud, from January 1st, 1982, to December 31 , 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indic ations for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 p atients (42%). All patients had drainage. The mortality and morbidity rates were 5,5% and 20%, respectively. No major septic or thromboembol ic complications occurred. There was only one major bleeding complicat ion. The advantages of splenectomy included histopathological diagnosi s in 13 of 14 patients with splenomegaly of unknown origin, permanent pain relief in all cases, and immediate correction of hematological cy topenia in 27 cases (75%). We conclude that the large weight of the sp leen does not constitute a contraindication to splenectomy, but indica tions must be carefully selected, and the operative and perioperative management, must be appopriate.