Splenectomy in high risk patients with splenomegaly

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.