Background: Laparoscopic splenectomy (LS) has evolved as treatment of choice for mild-tomoderately-enlarged spleens and for benign haematological disorders. Enlarged spleens increase the technical difficulties associated with LS. The aim of this study was to analyze the impact of splenic weight & measures on the results of LS. Patients and methods: We undertook a retrospective cohort study done of prospective maintained data of 30 patients undergoing laparoscopic splenectomy for hematological diseases at general surgery department of Zagazig University hospitals. The methodology has been adapted from personal series by lateral technique. The data included patient age, hematological diagnosis, duration of operation, operative blood loss, size of spleen, conversion to open, postoperative splenic weight , complications, length of hospital stay, mortality, and the duration of follow-up. Results:During the study, there were 30 consecutive laparoscopic splenectomies performed. There were 30 patients (24 females, 6 males). The age of presentation range 12-40. The mean duration of symptoms was range 1.3-12.23 years. The average splenic size determined preoperatively range 10- 22.5 cm. The diagnosis was Idiopathic Thrombocytopenic Purpura in 12 (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 4, thalassemia in12 and autoimmune hemolytic anemia in 2.Laparoscopic splenectomy could be completed in 26 (86.66%) patients. The remaining 4 (13.33%) needed conversion to open. Splenic weight after extraction was range 295-730gm. splenic weight can predict success of laparoscopic splenectomy as conversion occurs at splenic weight range700- 730gm).Postoperative morbidities were seen in 8 patients (26.66%). Postoperatively, one patient developed splenic and partial portal vein thrombosis and started on heparin and later warfarin hisvessels recanalized at 9 months of follow-up without any symptoms. Postoperative pneumonia occurred in 2 of the converted ones, none in the laparoscopic group (6.66%). three cases (10%) mild degree fever (38-38.5) in the 2nd and 3rd days postoperatively which are controlled by medical treatment, two of them were of conversion cases. four cases are presented by infection in the wound. They were managed by repeated dressings until become clean then are closed by secondary sutures. Only one case in the conversion cases had subphrenic collection. No other long-term complications were noted. Conclusion: Selection of patient parameters regarding splenic weight & diameter to carry out successful laparoscopic surgery. Conversion to open is not a failure or complication but safety of the patient comes first. Extensive experience of laparoscopic surgery is required for carrying out LS on large spleens to prevent complications and conversion to OS.

Laparoscopic Splenectomy;Idiopathic Thrombocytopenic Purpura.