Laparoscopic Spleen Surgery: Procedure, Complications, Reoperations and Tips and Tricks

Abstract

Splenic surgery can be either diagnostic or therapeutic and can involve a partial or total resection of the organ. The main risk factors for perioperative complications are haematological disorders, use of anticoagulants and portal hypertension. The most common complication is bleeding, followed by postoperative pancreatitis. Abscesses develop mainly in the splenic fossa after a splenectomy. Infections are far more infrequent after partial resections. Intraoperative bleeding is due either to vascular injury during dissection of the hilum or to an accidental capsular lesion. The latter can be staunched with several minutes’ compression or simply with a haemostyptic.

Vascular bleeding can be a challenge, especially when it stems from a vein imbedded in fatty tissue. Even the most minor bleed should be coagulated or clipped immediately. Effective coagulation instruments such as the LigaSure® or ultrasonic shears can help to reduce bleeding complications.

Key elements for complication-free splenic surgery are knowledge of the surgical anatomy, as well as adherence to preventive measures and to the step-by-step dissection technique.