The Diagnostic Utility of Splenectomy in Idiopathic Splenomegaly

Introduction With increasing frequency, patients with idiopathic splenomegaly are referred to surgeons for splenectomy. We evaluated the diagnostic utility of splenectomy and feasibility of a minimally invasive approach in the face of idiopathic splenomegaly. Methods We retrospectively reviewed 68 p...

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Bibliographic Details
Published in:World journal of surgery 2020-09, Vol.44 (9), p.2959-2964
Main Authors: Naples, Robert, Bertke, Alexander, Fafaj, Aldo, Zolin, Samuel J., Thomas, Jonah D., Petro, Clayton, Krpata, David, Prabhu, Ajita S., Rosen, Michael J., Rosenblatt, Steven
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aged
Biopsy
Bleeding
Bone marrow
Cardiac Surgery
Diagnosis
Diagnostic systems
Female
General Surgery
Hemorrhage
Humans
Laparoscopy
Laparoscopy - adverse effects
Laparoscopy - methods
Lymphadenopathy
Lymphadenopathy - pathology
Lymphoma
Male
Malignancy
Medicine
Medicine & Public Health
Middle Aged
Original Scientific Report
Peripheral blood
Retrospective Studies
Spleen
Spleen - pathology
Splenectomy
Splenectomy - adverse effects
Splenectomy - methods
Splenomegaly
Splenomegaly - pathology
Splenomegaly - surgery
Surgery
Thoracic Surgery
Vascular Surgery
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Summary:Introduction With increasing frequency, patients with idiopathic splenomegaly are referred to surgeons for splenectomy. We evaluated the diagnostic utility of splenectomy and feasibility of a minimally invasive approach in the face of idiopathic splenomegaly. Methods We retrospectively reviewed 68 patients who underwent splenectomy for idiopathic splenomegaly. The primary endpoint was the rate of definitive diagnosis based on final surgical pathology of the removed spleen. Results Preoperative workup included a bone marrow biopsy and peripheral blood smear in 93% and 100% of patients, respectively, with none having lymphadenopathy warranting biopsy. Splenectomy provided a definitive diagnosis for 44 (64.7%) patients. Of these, 34 (50%) patients had an underlying malignancy, of which more than half were splenic marginal zone lymphoma. There were 33 (48.5%) laparoscopic, 23 (33.8%) open, 10 (14.7%) laparoscopic converted to open, and two (2.9%) laparoscopic hand-assist cases. Conversion to open was due to splenic size [median craniocaudal length 21.8 cm (cm)] in eight and staple line bleeding at the splenic hilum in two patients. Overall, the laparoscopic approach was completed in patients with a smaller splenic size compared to open (median craniocaudal length 15.2 vs. 26.0 cm, p  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-020-05566-3