Splenic Hilum Management During Laparoscopic Splenectomy

Vecchio, Rosario; Marchese, Salvatore; Swehli, Ehab; Intagliata, Eva
October 2011
Journal of Laparoendoscopic & Advanced Surgical Techniques;Oct2011, Vol. 21 Issue 8, p717
Academic Journal
Background: The division of the splenic hilum is the most delicate step during laparoscopic splenectomy. An incorrect approach could lead to a series of related complications. Aim of the study was to report authors' personal experience in a series of 107 laparoscopic splenectomies where the splenic hilum was approached by means of stapling device. A possible relationship between instruments used to divide the splenic artery and vein and complications was analyzed. Methods: Laparoscopic splenectomy was performed in 107 cases at authors' institution between 1998 and January 2011. In all the patients, splenic hilum was approached by means of vascular stapler. Results: Indications for the spleen removal mainly were hematologic disorders. Associated surgical procedures were performed in 32 cases. Among the 13 patients who required a conversion to open splenectomy, only in 3 cases the reason was related to the hilum management. Postoperative complications included portal vein thrombosis in 3 cases, pancreatic fistula in 1 case, and bleeding, requiring reintervention, in 2 cases. Conclusions: The use of the stapling device is a safe and effective method to approach the splenic hilum during laparoscopic splenectomy. In experienced hands it showed a low rate of related complications.


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