BACKGROUND: Splenectomy in patients with massive splenomegaly and hematolog
ic malignancy results in higher morbidity and mortality with primarily pall
iative benefit.
METHODS: From a 14-year experience with 172 splenectomies, the perioperativ
e course of 39 high-risk patients with splenomegaly was reviewed for comorb
idities, indications, complications, and mortality.
RESULTS: Twenty-three males and 16 females with a mean age of 54.2 years an
d a mean 12.8-day postoperative length of stay were reviewed. Sixteen patie
nts (41%) had 23 major complications related to age (P = 0.047) and operati
ve time (P = 0.01), Intraoperative transfusion was related to splenic size
(P = 0.04), and estimated blood loss (P = 0.02) was inversely related to us
e of splenic artery preligation. Three perioperative deaths were secondary
to sepsis and multiorgan system failure.
CONCLUSION: Splenomegaly and comorbidities of the primary disease result in
higher morbidity and mortality. Splenic artery preligation is valuable to
limit intraoperative blood loss and facilitate splenectomy. Am J Surg. 1999
;178:581-586. (C) 1999 by Excerpta Medica, Inc.