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Comparative treatment and literature review for laparoscopic splenectomy alone versus preoperative splenic artery embolization splenectomy

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Abstract

Background

Although laparoscopic splenectomy has been gradually regarded as an acceptable therapeutic approach for patients with massive splenomegaly, intraoperative blood loss remains an important complication. In an effort to evaluate the most effective and safe treatment of splenomegaly, we compared three methods of surgery for treating splenomegaly, including open splenectomy, laparoscopic splenectomy, and a combination of preoperative splenic artery embolization plus laparoscopic splenectomy.

Methods

From January 2006 to August 2011, 79 patients underwent splenectomy in our hospital. Of them, 20 patients underwent a combined treatment of preoperative splenic artery embolization and laparoscopic splenectomy (group 1), 30 patients had laparoscopic splenectomy alone (group 2), and 29 patients underwent open splenectomy (group 3). Patients’ demographics, perioperative data, clinical outcome, and hematological changes were analyzed.

Results

Preoperative splenic artery embolization plus laparoscopic splenectomy was successfully performed in all patients in group 1. One patient in group 2 required an intraoperative conversion to traditional open splenectomy because of severe blood loss. Compared with group 2, significantly shorter operating time, less intraoperative blood loss, and shorter postoperative hospital stay were noted in group 1. No marked significant differences in postoperative complications of either group were observed. Compared with group 3, group 1 had less intraoperative blood loss, shorter postoperative stay, and fewer complications. No significant differences were found in operating time. There was a marked increase in platelet count and white blood count in both groups during the follow-up period.

Conclusions

Preoperative splenic artery embolization with laparoscopic splenectomy reduced the operating time and decreased intraoperative blood loss when compared with laparoscopic splenectomy alone or open splenectomy. Splenic artery embolization is a useful intraoperative adjunctive procedure for patients with splenomegaly because of the benefit of perioperative outcomes.

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Acknowledgments

The study was supported by a grant from the West China Hospital, Sichuan University.

Disclosures

Zhing Wu, Jin Zhou, and Bing Peng have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China

    Jin Zhou

  2. Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China

    Zhong Wu, Prasoon Pankaj & Bing Peng

Authors
  1. Zhong Wu
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  2. Jin Zhou
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  3. Prasoon Pankaj
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  4. Bing Peng
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Corresponding author

Correspondence to Bing Peng.

Additional information

Z. Wu and J. Zhou contributed equally to this work.

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Wu, Z., Zhou, J., Pankaj, P. et al. Comparative treatment and literature review for laparoscopic splenectomy alone versus preoperative splenic artery embolization splenectomy. Surg Endosc 26, 2758–2766 (2012). https://doi.org/10.1007/s00464-012-2270-z

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  • DOI: https://doi.org/10.1007/s00464-012-2270-z

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