Hand-assisted laparoscopic technique in the setting of complicated splenectomy: a 9-year experience.

Abstract

Laparoscopic splenectomy (LS) is significantly more challenging in patients with supramassive splenomegaly and those with portal hypertension. We hypothesized that hand-assisted laparoscopic splenectomy (HALS) could facilitate the procedure in these patients. Before October 2009, patients with supramassive splenomegaly and those with portal hypertension underwent LS. After October 2009, we routinely applied HALS in patients with these disorders. We compared the HALS group (n = 41) with the LS group (n = 45). There were no conversions to open surgery in the HALS group, whereas there was an 4.5 % conversion rate in the LS group. The operating times were shorter, and there was less estimated blood loss, and fewer major complications in the HALS group. Analgesia requirement, time to full diet, and postoperative stay were comparable in the two groups. We concluded that HALS was superior to LS in patients with supramassive splenomegaly and in those with portal hypertension.