Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy

Background/Purpose. Laparoscopic splenectomy is occasionally converted to open surgery due to massive intraoperative bleeding. The aim of this study was to identify the risk factors for massive bleeding during laparoscopic splenectomy. Methods. Fifty-three patients underwent laparoscopic splenectomy. The indications were hematologic disease in 25 patients, liver cirrhosis in 17 patients, and other conditions in 11 patients. Univariate analysis was conducted with Fisher's exact test, and multivariate analysis was conducted with a stepwise logistic regression model. Results. None of the patients required open surgery. Blood loss of more than 800ml was defined as massive intraoperative bleeding. Univariate analysis showed significant risk factors for massive bleeding to be liver cirrhosis, portal hypertension, splenomegaly, Child class, and preoperative platelet count. Independent risk factors in the multivariate analysis were portal hypertension and Child class. Conclusions. Careful attention to intraoperative bleeding during laparoscopic splenectomy is necessary for patients with portal hypertension and/or deteriorated liver function.