Preoperative splenic artery embolization in moderate splenomegaly undergoing elective laparoscopic splenectomy: a randomized controlled trial.

Abstract

Background: Laparoscopic splenectomy (LS) for moderate splenomegaly remains technically demanding due to limited working space and increased vascularity. Pre-operative splenic artery embolization (SAE) has shown benefits in massive splenomegaly, but its role in moderate cases is unclear.

Methods: This open-label randomized controlled trial was conducted at a tertiary care center. Patients aged 15 years and above with moderate splenomegaly undergoing elective LS were randomized into two groups: Group A (pre-operative SAE + LS) and Group B (LS alone). Primary outcomes included intra-operative blood loss, conversion to open surgery, mean operative time, and post-operative length of stay. Secondary outcomes included short-term post-operative complications and post-splenectomy hematological changes.

Results: A total of 40 patients were randomized (20 per group). The intraoperative blood loss was comparable between Group A [100(50-550)] ml and Group B [100(50-2000)] ml, p < 0.228). The conversion rates were similar across both groups (5% in Group A vs. 10% in group B). Operative time was slightly longer in Group B (79.9 ± 19.2 min) compared to Group A (90.5 ± 32.0 min; p = 0.210), but not statistically significant. Mean post-operative hospital stay was similar (4.35 ± 0.8 days in Group A vs. 4.75 ± 1.4 days in Group B) Post-operative complications, including pancreatic leak and atelectasis, were similar across both the groups.

Conclusion: The results of preoperative SAE with LS are equivocal to LS alone in patients undergoing elective LS for moderate splenomegaly. While SAE resulted in reduced intraoperative blood loss, the results were not statistically significant. Randomized trials with larger sample sizes and multicentric studies are required to achieve a consensus.