2023 Volume 29 Issue 1 Pages 27-32
Splenectomies are widely performed using a laparoscopic approach, but there are no reports of a left-open thoracoabdominal approach (left thoracotomy with laparotomy).
As of 2021, we have performed splenectomies using a left-open thoracoabdominal (Thoraco group, n = 11) or laparoscopic (Laparo group, n = 10) approach. Background and operation data for each of the patients were analyzed. The Thoraco group comprised 4 men and 7 women (median age 71) with splenic malignancy (n = 5), idiopathic portal hypertension (n = 1), Epstein-Barr virus-associated inflammatory pseudotumor (n = 1), epithelial cyst (n = 1), splenic arteriovenous fistula (n = 1), hypersplenism (n = 1), and left-sided portal hypertension (n = 1). The estimated median volume of the spleen was 697 ml. The Laparo group comprised 6 men and 4 women (median age 71) with splenic malignancy (n = 5), idiopathic thrombocytopenic purpura (n = 3), hemorrhagic hamartoma (n = 1), and hereditary spherocytosis (n = 1). The estimated median volume of the spleen was 213 ml.
The backgrounds of both groups were similar except the Thoraco group had a larger preoperative estimated spleen volume (697 vs 213 ml, p < 0.05); the Thoraco group also had a shorter operation time (180 vs 304 min, p < 0.01), and fewer pancreatic fistulas (n = 1 vs n = 5, p < 0.05).
In limited cases, splenectomy was safely performed using a left-open thoracoabdominal approach.
