To investigate the safety, feasibility and effect of laparoscopic splenectomy (LS) in the treatment of patients with massive splenomegaly.

The clinical data of 362 patients who underwent LS from Jan. 2012 to Dec. 2019 were retrospectively analyzed. According to the length of spleen, all the patients were divided into massive splenomegaly group and non-massive splenomegaly group. The operative outcomes, postopertive recovery, routine blood, blood coagulation functions, complications and follow-up situations in the two groups of patients were compared.

Operation time in the massive splenomegaly was longer than that in the non-massive splenomegaly, with statistically significant differences between groups(P<0.05). There were no significant differences in intraoperative blood loss, time of postoperative abdominal drainage-tube removal, time of gastrointestinal function recovery and duration of hospital stay(P>0.05). There were no significant differences in WBC, HGB and PT on postoperative day 1, postoperative day 3 and postoperative day 5(P>0.05). There were no significant differences in PLT on postoperative day 1(P>0.05). PLT in the massive splenomegaly group were significantly higher than that in the non-massive splenomegaly group on postoperative day 3 and day 5(P<0.05). The main complications included intra-abdominal bleeding, intra-abdominal infection, pulmonary infection, pancreatic fistula, portal vein system thrombosis(portal venous system thrombosis, PVST) and incision infection between the two groups showed no significant difference(P>0.05). There were no significant differences in WBC, PLT, HGB and PT on postoperative 1-month and 12-month(P>0.05). The incidence of PVST was 12.4%, and PVST was significantly correlated with BMI, D-dimer, PLT, diameter of portal vein , velocity of splenic vein, and preoperative PVST(P<0.05).

LS for massive splenomegaly is safe, feasible and effective, and early anticoagulant therapy postoperative can reduce PVST.