Hand-assisted laparoscopic splenectomy in patients with splenomegaly or prior upper abdominal operation

Background. Laparoscopic splenectomy (LS) in patients with significant splenomegaly or prior upper abdominal operation is technically challenging with a high conversion rate to open operation. We hypothesized that hand-assisted laparosopic splenectomy (HLS) in this setting would improve operative (OR) outcomes without impacting post-OR ileus, length of stay, morbidity, or mortality, compared with LS. Methods. All patients with splenomegaly (spleen weight greater than or equal to 500 g) or prior upper abdominal operation undergoing LS or HLS between March 1996 and June 2001 were reviewed. Nonparametric continuous valuables were expressed as median and intraquartile range with statistical significance determined by Wilcoxon rank sum test. Results. Of 41 patients reviewed, 22 underwent HLS, whereas 19 underwent LS, Median OR time for HLS was significantly less than for LS (161 minutes vs 212 minutes, P = .004). HLS was associated with a lower conversion rate (13.6% vs 36.8%, P = .08) and blood loss (325 mL vs 550 mL, P = .18) than LS, which approached statistical significance. HLS did not increase post-OR ileus, length of stay morbidity, or mortality. Conclusions. HLS in patients with significant splenomegaly or prior upper abdominal operation significantly shortens OR time compared with LS without adversely impacting post-OR ileus, length of stay morbidity, or mortality. In addition, HLS may be associated with a lower conversion rate and decreased blood loss.