Safety and efficacy of laparoscopic splenectomy in hematologic diseases with massive splenomegaly

Abstract

Splenomegaly and massive splenomegaly are common clinical findings in hematological diseases especially in inherited hemoglobin disorders (sickle cell disease and thalassemia) and hematologic malignancies. Laparoscopic splenectomy (LS) is the gold standard management of most splenic pathologies in which medical therapy fails to control the symptoms or complications. However, splenomegaly could be a challenging task for a laparoscopic removal. In this study, the authors explored the feasibility of LS in patients with splenomegaly and massive splenomegaly using a totally laparoscopic approach. This is a prospective case series of 18 patients (4–27 years old) who were operated from January 2014 till April 2016 with splenomegaly because of sickle cell disease, thalassemia, or both in a secondary-level hospital, Qatif, Eastern Province, KSA. A total of eight patients had hypersplenism, and 10 patients had very big spleens with abdominal pain and pressure symptoms. Male : female ratio was 3 : 1. The operative time was significantly prolonged in massive splenomegaly, mainly because of extraction time. One case was converted to open because of intraoperative bleeding. The operated maximum spleen size was 23 cm in longitudinal axis. Median hospital stay was 2.5 day. There was no overwhelming postsplenectomy sepsis. There were no mortalities. Although massive splenomegaly was associated with increased rates of open conversion, LS in splenomegaly is feasible and safe in experienced hands.