Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic splenectomy: a surgeon’s experience of 302 patients with analysis of postoperative complications

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the operative and clinical outcomes in a series of 302 consecutive laparoscopic splenectomies and to analyze the risk factors of postoperative complications.

Methods

The study retrospectively reviewed 302 consecutive patients who underwent laparoscopic splenectomy. The patients were classified into three disease groups: benign spleen-related disease (group 1, n = 196), malignant spleen-related disease (group 2, n = 42), and portal hypertension (group 3, n = 64). The three groups were compared in terms of perioperative data. Postoperative complications were classified into three complication groups according to the Clavien–Dindo Classification of Surgical Complications and Severity: no complication, mild complications, and severe complications. Multivariate logistic regression was used to analyze the independent risk factors of postoperative complications.

Results

The patients in group 1 were younger and had a higher body mass index, a lower American Society of Anesthesiology (ASA) score, and a smaller spleen than the patients in groups 2 and 3. Fewer patients in group 1 required hand-port assistance than in the other two groups. Group 1 had shorter operative times, required fewer transfusions, presented a lower incidence of complications, and had shorter postoperative stays than groups 2 and 3. In the analysis of complications, high ASA score was an independent risk factor for the occurrence of complications. Both high ASA score and larger spleen size were independent risk factors for the occurrence of severe complications. Compared with total laparoscopic splenectomy, the data including the hand-assisted cases showed a reduction in odds ratio for both the occurrence of complications and the occurrence of severe complications.

Conclusions

The treatment of malignant spleen-related disease and portal hypertension with laparoscopic splenectomy is more challenging than the treatment of benign disease. High ASA score is an independent risk factor for the occurrence of complications, whereas high ASA score and larger spleen size are both independent risk factors for the occurrence of severe complications. The appropriate introduction of the hand-assisted technique may facilitate the laparoscopic procedure and reduce postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach: report of a case. Presse Med 20:2263

    PubMed  CAS  Google Scholar 

  2. Knauer EM, Ailawadi G, Yahanda A et al (2003) 101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders. Am J Surg 186:500–504

    Article  PubMed  Google Scholar 

  3. Schlachta CM, Poulin EC, Mamazza J (1999) Laparoscopic splenectomy for hematologic malignancies. Surg Endosc 13:865–868

    Article  PubMed  CAS  Google Scholar 

  4. Wang Y, Zhan X, Zhu X et al (2010) Laparoscopic splenectomy in portal hypertension: a single-surgeon 13-year experience. Surg Endosc 24:1164–1169

    Article  PubMed  Google Scholar 

  5. Cai YQ, Zhou J, Chen XD et al (2011) Laparoscopic splenectomy is an effective and safe intervention for hypersplenism secondary to liver cirrhosis. Surg Endosc 25:3791–3797

    Article  PubMed  Google Scholar 

  6. Habermalz B, Sauerland S, Decker G et al (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European association for endoscopic surgery (EAES). Surg Endosc 22:821–848

    Article  PubMed  CAS  Google Scholar 

  7. Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 134:647–653

    Article  PubMed  Google Scholar 

  8. Grahn SW, Alvarez JR, Kirkwood K et al (2006) Trends in laparoscopic splenectomy for massive splenomegaly. Arch Surg 141:755–762

    Article  PubMed  Google Scholar 

  9. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  10. Mahon D, Rhodes M (2003) Laparoscopic splenectomy: size matters. Ann R Coll Surg Engl 85:248–251

    Article  PubMed  Google Scholar 

  11. Katkhouda N, Lord RV (2000) Once more, with feeling: handoscopy, or the rediscovery of the virtues of the surgeon’s hand. Surg Endosc 14:985–986

    Article  PubMed  CAS  Google Scholar 

  12. Hellmann P, Ardvinsson D, Rastad J (2000) Handport-assisted laparoscopic splenectomy in massive splenomegaly. Surg Endosc 14:1177–1179

    Article  Google Scholar 

  13. Baccarani U, Donini A, Terrosu G et al (1999) Laparoscopic splenectomy for hematological diseases: review of current concepts and opinions. Eur J Surg 165:917–923

    Article  PubMed  CAS  Google Scholar 

  14. Makrin V, Avital S, White I et al (2008) Laparoscopic splenectomy for solitary splenic tumors. Surg Endosc 22:2009–2012

    Article  PubMed  Google Scholar 

  15. Tessier DJ, Pierce RA, Brunt LM et al (2008) Laparoscopic splenectomy for splenic masses. Surg Endosc 22:2062–2066

    Article  PubMed  CAS  Google Scholar 

  16. Schuppan D, Afdhal NH (2008) Liver cirrhosis. Lancet 371:838–851

    Article  PubMed  CAS  Google Scholar 

  17. Anegawa G, Kawanaka H, Uehara H et al (2009) Effect of laparoscopic splenectomy on portal hypertension gastropathy in cirrhotic patients with portal hypertension. J Gastrenterol Hepatol 24:1554–1558

    Article  Google Scholar 

  18. Terrosu G, Baccarani U, Bresadola V et al (2002) The impact of splenic weight on laparoscopic splenectomy for splenomegaly. Surg Endosc 16:103–107

    Article  PubMed  CAS  Google Scholar 

  19. Hama T, Takifuji K, Uchiyama K et al (2008) Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. J Hepatobiliary Pancreat Surg 15:304–309

    Article  PubMed  Google Scholar 

  20. Poulin EC, Mamazza J, Schlachta CM et al (1998) Splenic artery embolization before laparoscopic splenectomy: an update. Surg Endosc 12:870–875

    Article  PubMed  CAS  Google Scholar 

  21. Iwase K, Higaki J, Mikata S et al (1999) Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly. Surg Laparosc Endosc Percutan Tech 9:197–202

    PubMed  CAS  Google Scholar 

  22. Wang X, Li Y, Zhou J et al (2012) Hand-assisted laparoscopic splenectomy is a better choice for patients with supramassive splenomegaly due to liver cirrhosis. J Laparoendosc Adv Surg Tech A 22:962–967

    Article  PubMed  Google Scholar 

  23. Rosen M, Brody F, Walsh RM et al (2002) Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc 16:272–279

    Article  PubMed  CAS  Google Scholar 

  24. Tomikawa M, Akahoshi T, Sugimachi K et al (2010) Laparoscopic splenectomy may be a superior supportive intervention for cirrhotic patients with hypersplenism. J Gastroenterol Hepatol 25:397–402

    Article  PubMed  Google Scholar 

  25. American Society of Anesthesiologists (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  26. Wolters U, Wolf T, Stutzer H et al (1996) ASA classification and perioperative variables as predictor of postoperative outcome. Br J Anaesth 77:217–222

    Article  PubMed  CAS  Google Scholar 

  27. Kavic SM, Segan RD, Park AE et al (2005) Laparoscopic splenectomy in the elderly: a morbid procedure? Surg Endosc 19:1561–1564

    Article  PubMed  CAS  Google Scholar 

  28. Patel AG, Parker JE, Wallwork B et al (2003) Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 238:235–240

    PubMed  Google Scholar 

  29. Casaccia M, Torelli P, Pasa A et al (2010) Putative predictive parameters for the outcome of laparoscopic splenectomy: a multicenter analysis performed on the Italian registry of laparoscopic surgery of the spleen. Ann Surg 251:287–291

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

Disclosures

Xin Wang, Yongbin Li, Nicolas Crook, Bing Peng, and Ting Niu have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

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

    Xin Wang, Yongbin Li & Bing Peng

  2. Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China

    Nicolas Crook

  3. Department of Hematology & Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Ting Niu

Authors
  1. Xin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yongbin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas Crook
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bing Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ting Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bing Peng.

Additional information

Xin Wang, Yongbin Li, Bing Peng and Ting Niu contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, X., Li, Y., Crook, N. et al. Laparoscopic splenectomy: a surgeon’s experience of 302 patients with analysis of postoperative complications. Surg Endosc 27, 3564–3571 (2013). https://doi.org/10.1007/s00464-013-2978-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2978-4

Keywords

Search

Navigation