Predictors for conversion in laparoscopic splenectomy: A prospective randomized study

Background & objectives: Laparoscopic splenectomy had become the golden standard for elective splenectomy, as it is feasible, safe and provides many advantages to the patients in comparison to open splenectomy, and the growing experience and the advances in equipment had made it feasible in situations that were thought to be contraindications in the past. However, some cases still require conversion to an open procedure. Identifying predictive factors for conversion   carries   crucial   benefits   for   patients   and   health   care   providers. Methods: 24 patients underwent elective laparoscopic splenectomy for different indications in our hospital between January 2008 and February 2010. Patients' data whether preoperative, operative or postoperative were collected and assessed statistically to identify the risk factors for conversion to open splenectomy. Results: The study included 24 patients (13 ITP, 5 spherocytosis, 4 chronic lymphocytic leukemia (CLL) and 2 Lymphoma patients). The rate of conversion was 16.7% (4 patients). The mean operative time was 116.5 ± 23.9 minutes; the mean estimated intraoperative blood loss was 286.5 ± 165.7 ml. The mean period until passage of flatus was 2 ± 1.1 days, patients resumed oral food intake in 3.2 ± 1.4 days and were discharged from the hospital in 4.6 ± 1.9 days. 4 patients had post operative complications in their hospital stay, and one needed reexploration. The significant risk factors for conversion in the study was diagnosis, ASA score 3, presence of technical difficulty, preoperative platelet count 17 cm and intraoperative blood loss > 500 ml. Conclusions: Proper analysis of all factors affecting successful completion of laparoscopic splenectomy will lead to better implementation of the procedure in context with patient's needs and the technical expertise of the surgical team, both leading to better outcomes. This will also help   to   address   the   areas   of   potential   improvements   to   be   implemented.