Trends in Laparoscopic Splenectomy for Massive Splenomegaly

Grahn, Sarah W.; Alvarez, Jesus; Kirkwood, Kimberly S.

doi:10.1001/archsurg.141.8.755

Cited by 96 publications

(84 citation statements)

References 15 publications

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“…The procedure has tended to take longer than open splenectomy with median operating times in recently reported series of 85-231 min; [2][3][4][5][6] however, it is associated with low morbidity rates of 18-26% 2,5,7 and zero mortality in some series 5,[7][8][9][10] with others recently reporting mortality of up to 4%. 2,4,11,12 The hospital stay is also shorter 7,13 with mean hospital stay reported of 2.4-5 days 5,6,8,10,12,14,15 and even one small series reported successful day-case laparoscopic splenectomy. 15 There is not an increased risk of missing accessory spleens, 16 and the conversion rate to open operation is reported at 0-15% in recent series.…”

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confidence: 99%

Laparoscopic splenectomy: a personal series of 140 consecutive cases

Pattenden

Mann

Metcalfe

et al. 2010

annals

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Ann R Coll Surg Engl 2010; 92: 398-402 398Since the first laparoscopic splenectomy in 1991, 1 the procedure has been rapidly established as a safe and effective treatment for a range of benign and malignant haematological conditions. The procedure has tended to take longer than open splenectomy with median operating times in recently reported series of 85-231 min; 2-6 however, it is associated with low morbidity rates of 18-26% 2,5,7 and zero mortality in some series 5,7-10 with others recently reporting mortality of up to 4%. 2,4,11,12 The hospital stay is also shorter 7,13 with mean hospital stay reported of 2.4-5 days 5,6,8,10,12,14,15 and even one small series reported successful day-case laparoscopic splenectomy. 15 There is not an increased risk of missing accessory spleens, 16 and the conversion rate to open operation is reported at 0-15% in recent series. [2][3][4][5][6]9,10,14,15,18,19 Little data are present in the literature examining the role of laparoscopic splenectomy in the case of splenomegaly, and there has been concern regarding higher conversion rates and morbidity. 20 Several reports suggest advantages of hand-assisted techniques with laparoscopic splenectomy for massive spleens. 4,15,21 However, recently, a small series did not require hand assistance or conversion to open operation in the latter part of their experience. 12Other centres have advocated open splenectomy for spleens larger than 1 kg. 22The aim of this study was to evaluate the results of a large, single-centre experience of laparoscopic splenectomy, focusing on morbidity, hospital stay, and conversion to open operation. In particular, the role of laparoscopic splenectomy in cases of splenomegaly over 1 kg was examined. RESULTS In total 140 laparoscopic splenectomies were performed with a complication rate of 15% and no mortality. The median operative time was 100 min and conversion to open procedure was necessary in 2.1%. Conversion for cases of splenomegaly was only 5.7%. The median hospital stay was 3 days. CONCLUSIONS Laparoscopic splenectomy is a safe procedure with acceptable morbidity. A laparoscopic approach for splenomegaly is feasible. Patients and Methods Study design

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confidence: 99%

Laparoscopic splenectomy: a personal series of 140 consecutive cases

Pattenden

Mann

Metcalfe

et al. 2010

annals

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“…In addition, subsets of spleens weighing 600–1600 g or more have been classified as massive or supramassive15, 16. This problem might be overcome with the wider assessment of splenic size by three‐dimensional reconstruction of CT images to calculate spleen volume.…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies1, 2, 3, 4, 5, 6, 7, 8 have reported mortality rates of 1·8–15 per cent and complication rates of 9–51 per cent. Numerous case reports and small series9, 10, 11, 12, 13, 14, 15, 16 have shown the feasibility of laparoscopic splenectomy for massive splenomegaly, but, as with open splenectomy, the criterion of a spleen weight greater than 1·5 kg has not been used consistently to refer to massive splenomegaly3, 17, 18. Some reports9 regarding the safety of laparoscopic approaches have included splenic specimens of only 500 g, whereas others10, 11, 12, 13 have included spleens of more than 600 or 1000 g. Other authors14, 15, 16 have categorized spleens weighing 600–1600 g as ‘massive’, and those weighing more than 1600 g as ‘supramassive’.…”

Section: Introductionmentioning

confidence: 99%

Surgery for massive splenomegaly

et al. 2017

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BackgroundSplenectomy for massive splenomegaly (spleen weight more than 1·5 kg) is commonly believed to be hazardous and to provide poor palliation. The aim of this cohort study was to investigate these issues and examine the many definitions of massive splenomegaly to see whether a better tool might be proposed for preoperative evaluation of these patients.MethodsMorbidity and long‐term outcomes were assessed in consecutive patients. Relief of pressure–volume‐related symptoms and sustainable independence from transfusion in patients were used to ascertain the impact of splenectomy.ResultsSplenectomy was performed in 56 patients, mainly for non‐Hodgkin's lymphoma and myeloproliferative diseases. Median spleen weight was 2·3 (range 1·5–6·0) kg. Mortality at 180 days was zero, and the postoperative complication rate was 25 per cent (17 complications in 14 patients). At 2 years, relief of pain was maintained in 33 of 34 patients, with sustained independence from transfusion in 15 of 19 patients with anaemia and nine of 11 with thrombocytopenia. Spleen weight correlated negatively with BMI (P = 0·036).ConclusionSplenectomy for massive splenomegaly is safe and provides effective palliation. Provisional cut‐off points relating to spleen size and BMI help to identify patients benefiting from a splenectomy, even those in a critical state.

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“…This technique was usually avoided in patients with moderate to severe splenomegaly due to expected difficulties during intra-operative manipulation while doing laparoscopic splenectomy [8] . Moreover high conversion rates to open procedure were also reported making LS a contraindication in patients with significant splenomegaly [9] . However with time there is improment in laparoscopic techniques and with experience many surgeons are reporting less conversion rates even in patients with moderate splenomegaly [10] .…”

Section: Introductionmentioning

confidence: 99%