Effect of spleen size on splenectomy outcome - A comparison of open and laparoscopic surgery

Background: Laparoscopic splenectomy (LS) is gaining acceptance as an alter native to open splenectomy (OS). However, splenomegaly presents an obstacle to LS, and massive splenomegaly has been considered a contraindication. An alyses comparing the procedure with the open approach are lacking. The purp ose of this study was to analyze the effect of spleen size on operative and immediate clinical outcome in a series of 105 LS compared with a series of 81 cases surgically treated by an open approach. Methods: Between January 1990 and November 1998, 186 patients underwent a s plenectomy for a wide range of splenic disorders. Of these patients, 105 we re treated by laparoscopy (group I, LS; data prospectively recorded) and 81 were treated by an open approach (group II, OS analyzed retrospectively). Patients also were classified into three groups according to spleen weight: group A, <400 g; group B, 400-1000 g; and group C, >1000 g. Age, gender, o perative time, perioperative transfusion, spleen weight, conversion rate, m ode of spleen retrieval (bag or accessory incision), postoperative analgesi a, length of stay, and morbidity were recorded in both main groups. Results: Operative time was significantly longer for LS than for OS. Howeve r, LS morbidity, mortality, and postoperative stay were all lower at simila r spleen weights. Spleens weighing more than 3,200 g required conversion to open surgery in all cases. When LS outcome for hematologic malignant diagn osis was compared with LS outcome for a benign diagnosis, malignancy did no t increase conversion rate, morbidity, and transfusion, even though maligna nt spleens were larger and accessory incisions were required more frequentl y. Postoperative hospital stay was significantly longer in malignant than i n benign diagnosis (5 +/- 2.4 days vs. 4 +/- 2.3 days; p < 0.05). Conclusions: In patients with enlarged spleens, LS is feasible and followed by lower morbidity, transfusion rate, and shorter hospital stay than when the open approach is used. For the treatment of this subset of patients, wh o usually present with more severe hematologic diseases related to greater morbidity, LS presents potential advantages.