Laparoscopic Partial Splenectomy Is Safe and Effective in Patients with Focal Benign Splenic Lesion

Xin Wang, PhD, Yongbin Li, PhD, Hua Zhang, PhD, Bing Peng, PhD. Department of Hepatobiliopancreatic surgery, West China Hospital, Chengdu, China.

Background: Traditionally, splenectomy is considered the treatment of choice for splenic lesions. The risk of early and late complications and the awareness of pivotal immunologic function of spleen, has pushed the development of spleen sparing techniques. This study aimed to evaluate the safety and effectiveness of laparoscopic partial splenectomy in selected patients.

Methods: From May 2011 we initiated performing laparoscopic partial splenectomy in patients with focal benign splenic lesion. The main surgical procedure consisted of four steps: 1. Mobilizing the perisplenic ligament; 2. Ligating and dissecting the vessels which supplying the involved spleen. 3. Dissecting the spleen along the demarcation. 4. Hemostasis using bipolar energy device. The remaining spleen was not routinely fixed except one case who underwent subtotal splenectomy. The perioperative data were collected and analyzed. The follow-up including evaluation of splenic regrowth(CT scan) and quality of life were routinely performed 6 months after surgery.

Results: From May 2011 to Augest 2013, laparoscopic partial splenectomy had been performed in 9 patients aged from 13 to 57 (mean 34). The indications included nonparasitic cyst(n=4), lymphangioma(n=3), and hemangioma(n=2). The mean operative time was 151min(range, 110-200min). The mean estimated blood loss was 186ml(range, 100-400ml). One patient was converted to laparoscopic splenectomy because of hemorrahging. Two patients suffered from postoperative complications: the one who was converted to laparoscopic splenectomy suffered from portal vein thrombosis, the other one underwent laparoscopic partial splenectomy suffered from fluid collection around splenic recess. There was no blood transfusion and postoperative mortality. All patients discharged uneventfully. The mean postoperative hospital stay was 5 days(range, 4-7days). Six patients finished the follow-up including evaluation of splenic regrowth and quality of life 6 months after surgery. The results demonstrated all these patients had different degrees of splenic regrowth and gained a good quality of life.

Conclusions: Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion. Meanwhile, this technique potentially retains some splenic immunity, and confers the benefit of a minimal access technique.

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