The Role of Pre-emptive Control of Vascular Pedicle in Laparoscopic Splenectomy: An Experience with 19 Consecutive Patients

Abstract

Laparoscopic splenectomy is an acceptable approach for elective splenectomy in Hematological conditions. Nevertheless, the anatomical location, several ligamentous attachments, friability of the splenic tissue and intra-operative bleeding are the major challenges faced by Laparoscopic surgeons. To meet these challenges, many approaches are in practice for splenic mobilization and control of vascular pedicle. Newer advances such as; ultracision, ligasure devices, endostaplers and hand assisted ports have all facilitated this complex operation. Intra-operative bleeding remains the main cause for conversions to open surgery. Several authors have shown that preoperative embolization or ligation of the splenic vessels reduces the intra-operative bleeding and conversion rate. The ligation of the splenic artery is a routine practice in conventional elective open splenectomy prior to mobilization of the spleen. We maintained the same general approach and ligated the splenic artery prior to mobilization of the spleen to avoid intra-operative bleeding. Intra-operative bleeding is the main cause of conversion in laparoscopic splenectomy. Several studies have shown that early ligation of the splenic artery before mobilization of the spleen decreases the likelihood of bleeding and the conversion rate. Furthermore, it also decreases the blood loss during surgery, reduces the size of spleen and makes dissection and manipulation of this fragile organ easy. This study aims to show that elective intracorporeal ligation of the splenic vessels is safe and by reducing the bleeding and blood loss during surgery, it can facilitate laparoscopic splenectomy.