SPLENIC ARTERY EMBOLIZATION BEFORE LAPAROSCOPIC SPLENECTOMY - AN UPDATE

Background: This study assessed preoperative splenic artery embolizati on before laparoscopic splenectomy. Methods: Preoperative splenic arte ry embolization was used in 26 of 54 patients (48%) undergoing laparos copic splenectomy. Between 1992 and 1994, this procedure was used in a ll patients with spleens shorter than 20 cm (group I), except the firs t two (18/20). An anterior surgical approach was used. After 1994 (gro up II), embolization was not used for these patients (0/26), and a lat eral surgical approach was used. Throughout the study period, all pati ents with spleens longer than 20 cm had embolization (8/8). Results: F ive complications occurred, three related to the use of small-particle embolic material (microspheres, gelatin foam powder). In group I, the conversion rate was lower than that of most current series, largely b ecause of embolization. In group II, similar results were obtained bec ause of experience and a better surgical approach (i.e., lateral). Con clusions: Preoperative splenic artery embolization is not necessary fo r spleens shorter than 20 cm. Increased experience and mostly the late ral surgical approach have permitted a shorter operation and a low con version rate (4%) similar to the rate achieved with embolization and t he anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolizat ion, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).