SPLENOMEGALY SHOULD NOT BE CONSIDERED A CONTRAINDICATION FOR LAPAROSCOPIC SPLENECTOMY

Objective To analyze the impact of spleen size on operative and immedi ate clinical outcome in a series of 74 laparoscopic splenectomies (LS) . Summary Background Data LS is gaining acceptance as an alternative t o open splenectomy. However, splenomegaly hinders LS, and massive sple nomegaly has;been considered a contraindication. Methods Between Febru ary 1993 and September 1997,74 patients with a wide range of splenic d isorders, were treated by laparoscopy and prospectively recorded. They were classified into three groups according to spleen weight: group I , <400 g (n = 52); group ii, 400 to 1000 g (n = 9); and group III, >10 00 g (n = 13), Age, operative time, number of-trocars required, need f or perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia requirements, length of hospital stay, and morbidity rates were record ed. Results LS was completed in 69 patients, and the conversion rate w as thus 6.7%. Operative time was significantly longer in patients with larger spleens, and an accessory incision was more frequently require d. However, there were no significant differences in transfusion rate, length of stay, severe morbidity, or conversion rate. Conclusions Pre liminary evaluation df LS for patients with large spleens suggests tha t it requires a longer operative time, but it is feasible-arid may pot entially offer the same advantages (shorter stay and faster recovery) as it does to those with smaller spleens.