Laparoscopic
splenectomy (LS) is nowadays considered as the gold standard for most
hematological diseases where
splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen
lymphoma, a big splenic artery aneurism, or a spleen
infarct due to a huge pancreatic pseudo-
cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision,
hospital stay, and complications were analyzed. We had 14 cases of malignant
splenic disease, the most frequent malignant diagnosis was
non-Hodgkin's lymphoma (12/14, 85.7 %).
Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive
splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to
laparotomy occurred in two patients (4.16 %), both associated to uncontrollable
bleeding in patients with
splenomegaly. Mean
operative time was 138 ± 22 min. Mean
hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-
splenectomy infection (OPSI). LS can be performed safely for malignant
splenic disease and
splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive
splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease,
splenomegaly, or unusual cases. Massive
splenomegaly should be considered as relative
contraindication to LS even at experienced centers.