Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: Does size matter?

Laparoscopic resection has become the standard means for removal of normal- sized spleens in many medical centers. The application of minimally invasiv e techniques in the setting of splenomegaly is less well defined and was pr eviously considered a contraindication to the laparoscopic approach. The pu rpose of this prospective study of consecutive patients was to compare the outcomes of patients undergoing laparoscopic splenectomy for normal-sized s pleens (150 g or less) versus those with clear evidence of splenomegaly (50 0 g or greater). One hundred forty-two patients met the inclusion criteria. The most common diagnosis in the normal-sized spleen group was idiopathic thrombocytopenia purpura (67 of 82, 82%). Malignant hematologic diseases (l ymphoma and leukemia) were the most common diagnoses in the splenomegaly gr oup (35 of 60, 58%). Mean operative times (127 vs 172 minutes) and estimate d blood loss (123 vs 173 cm(3)) were lower for those patients with normal-s ized spleens (P<0.05). There were no statistical differences in conversion rates, lengths of stay, or complications between the two groups. We conclud e that laparoscopic splenectomy is safe and effective in the setting of spl enomegaly despite modest but statistically longer operative times and incre ased operative blood loss when compared with laparoscopic splenectomy for n ormal-sized spleens.