Laparoscopic Splenectomy for Hematologic Disorders: A Safe Procedure.

Background : Splenectomy for hematological diseases remains controversial in many circumstances due to a high morbidity and mortality after a classical surgery. Laparoscopic surgery becoming more popular, spleen removal by this approach was more widely used and we retrospectively reviewed the outcome of 33 patients who underwent laparoscopic splenectomy in our institution.

Population : Between 1998 and 2006, laparoscopic splenectomy was performed in 33 patients (F=6, M=27) by an anterior approach. Median age was 62 (40–90) y.o. Indications for splenectomy was hemolytic anemia or discomfort in malignant hemopathies (CML, MF, NHL, CLL, HD) and autoimmune cytopenia or peripheral cytopenia in non malignant hemopathies (AIHA, ITP,.). Spleen weights ranged from 100g to 5000g. All the patients received anti-pneumococcal vaccination 2 weeks before surgery. After surgery, all patients were covered by penicillin and LMWH until discharge from the hospital.

Results : Perioperative mortality was 0% and major postoperative complications were observed in 3 patients (Pulmonary Embolism, DVT, Hemorrhage). Conversion was required in one patient. One patient died 4 years after splenectomy from extended deep portal thrombosis.

Improvement in hematological parameters and/or performans status was observed in 95% of the patients. Mean duration of hospital stay was 5 days.

Conclusion : Anterior laparoscopic splenectomy for splenomegaly is a safe and minimally invasive procedure in the hands of experienced surgeons. Howerer, a closed monitoring of the platelets count should be performed, even on an ambulatory basis, because of the risk of thrombotic complications.