Site Overlay

Modern Surgical Approaches in Splenic Diseases

By Борис Попщерев

Volume 13, Issue 1

Original Article / Published: September 2025

DOI: https://www.doi.org/10.57045/jemis/1310925.pp54-60

V. Ivanov, P. Dimitrov, I. Teodosiev, K. Kyosev, Ts. Trichkov

Second Clinic of Abdominal Surgery, Military Medical Academy, Sofia

Abstract

Introduction: The use of the laparoscopic surgical approach in the surgical treatment of splenic diseases is the preferred method for a number of benign diseases in which the spleen is small to medium in size. In cases of splenomegaly, malignant diseases and traumatic injuries of the spleen, the method of choice remains conventional splenectomy.

Materials and Methods: Over a 5-year period (2020-2024), 316 patients with spleen diseases were operated on at the Military Medical Academy, Sofia. Of these, 147 were women and 169 were men in a ratio of 1.14:1. The average age of the patients was 54 years. The following indications for splenectomy were identified: hematological diseases (n=19); rupture (n=24); abscess (n=6); echinococcus (n=5); cyst (n=14); hamartoma (n=3); processes in other organs involving the spleen (n=185). The applied surgical methods include: laparoscopic splenectomy in 82 patients and conventional splenectomy in 234 patients.

Results: The average operative time for laparoscopic splenectomies was 170 min (140-220 min). Of the 82 laparoscopic splenectomies performed, conversion was achieved in 20 cases (24.3%). The average intraoperative blood loss was 200 ml (60-300 ml), with postoperative bleeding from the splenic bed observed in two cases (11.76%). The average operative time for conventional splenectomies was 90 min (30-150 min). The average intraoperative blood loss was 300 ml (200-500 ml). Of the 234 patients operated using the conventional method, three required reoperation due to postoperative bleeding, and one patient had evidence of suppuration of the surgical wound.

Conclusion: Laparoscopic splenectomy is the preferred method for benign diseases, some malignant diseases and very rarely for splenic trauma. In hypersplenism and traumatic injuries, the method of choice is conventional splenectomy. With laparoscopic splenectomy, patients recover faster, postoperative pain is less, there is a cosmetic effect and suppurations of the surgical wounds are rarer.

References

1.Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med 1991;20:2263 [PMID: 1838167]

  1. Palandri F, Polverelli N, Sollazzo D, et al. Have splenectomy rate and main outcomes of ITP changed after the introduction of new treatments? A monocentric study in the outpatient setting during 35 years. Am J Hema- tol 2016;91:E267-E272 [PMID: 26799593 DOI: 10.1002/ ajh.24310]
  2. Yong M, Schoonen WM, Li L, et al. Epidemiology of paedi- atric immune thrombocytopenia in the General Practice Research Database. Br J Haematol 2010;149:855-864 [PMID: 20377590 DOI: 10.1111/j.1365-2141.2010.08176.x
  3. Habermalz B, Sauerland S, Decker G, et al. Laparoscopic splenectomy: the clinical practice guidelines of the Europe- an Association for Endoscopic Surgery (EAES). Surg Endosc 2008;22:821-848 [PMID: 18293036 DOI: 10.1007/s00464-007- 9735-5]
  4. Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 2004;104:2623-2634 [PMID: 15217831 DOI: 10.1182/ blood-2004-03-1168]
  5. Vianelli N, Galli M, de Vivo A, Intermesoli T, Giannini B, Mazzucconi MG, Barbui T, Tura S, Baccaranion M; Gruppo Italiano per lo Studio delle Malattie Ematologiche dell’Adulto. Efficacy and safety of splenectomy in immune thrombo- cytopenic purpura: longterm results of 402 cases. Haematologica 2005;90:72-77 [PMID: 15642672]
  6. Bolton-Maggs PH, Langer JC, Iolascon A, Tittensor P, King MJ; General Haematology Task Force of the British Committee for Standards in Haematology. Guidelines for the diagnosis and management of hereditary spherocytosis—2011 update. Br J Haematol 2012;156:37-49 [PMID: 22055020 DOI: 10.1111/ j.1365-2141.2011.08921.x]
  7. Gigot JF, Mabrut JY, Matairie S, et al. Failures following laparoscopic splenectomy and their management with special reference to accessory spleens and splenosis. Prob Gen Surg 2002;19:80-94
  8. Wu JM, Lai IR, Yuan RH, Yu SC. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 2004;187:720-723 [PMID: 15191864 DOI: 10.1016/j.amj-surg.2003.11.032]
  9. Terrosu G, Baccarani U, Bresadola V, et al. The impact of splenic weight on laparoscopic splenectomy for spleno- megaly. Surg Endosc 2002;16:103-107 [PMID: 11961616 DOI: 10.1007/s00464-001-9045-2]
  10. Ermolov AS, Tlibekova MA, Yartsev PA, et al. Laparoscopic Splenectomy in Patients With Spleen Injuries. Surg Laparosc Endosc Percutan Tech 2015;25:483-486 [PMID: 26422089 DOI: 10.1097/ SLE.0000000000000207] 12. Dexter SP, Martin IG, Alao D, et al. Laparoscopic splenec- tomy. The suspended pedicle technique. Surg Endosc 1996;10:393-396 [PMID: 8661785]
  11. Bedirli A, Sozuer EM, Saglam A, et al. Grasper-assisted versus traditional laparoscopic splenectomy in the management of hematologic disorders. J Laparoendosc Adv Surg Tech A 2003;13:359-363 [PMID: 14733698 DOI: 10.1089/109264203322 656414]
  12. Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc. 2017 Sep 16;9(9):428-437. doi: 10.4253/wjge.v9.i9.428. PMID: 28979707; PMCID: PMC5605342.
  13. Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review PMID: 28438854 PMCID: PMC5461436 DOI: 10.21873/invivo.11058
  14. Corcione F, Pirozzi F, Aragiusto G, et al. Laparoscopic splenectomy: experience of a single center in a series of 300 cases Surg Endosc DOI 10.1007/s00464-012-2272-x
Volume 11, Issue 1
Article [pdf]

Keywords:

Splenectomy; Laparoscopic; Idiopathic thrombocytopenic purpura;
Splenomegaly

How to cite this article:

V. Ivanov, P. Dimitrov, I. Teodosiev, K. Kyosev, Ts. Trichkov. Modern Surgical Approaches in Splenic Diseases. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2025; 13(1): 54-60

Corresponding author:

Dr. Veselin Ivanov

Clinic of Surgery
Military Medical Academy, Sofia
E-mail:vesdimitrovbg@gmail.com