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Superior Results With a Combined Endovascular and Operative Approach

Jonathan R. Hiatt, MD; Antoinette S. Gomes, MD; Herbert I. Machleder, MD

Arch Surg. 1990;125(10):1363-1367.

Abstract
• Splenectomy for massive splenomegaly (drained splenic weight, > 1000 g) has an uncommonly high morbidity and mortality because of technical challenges and problems of hemostasis. In a group of 10 patients with massive splenomegaly due to myeloproliferative disorders (average splenic weight, 4193 g), we developed a management algorithm based on preoperative angiographic embolization of the splenic artery. Average operating time was 1.7 hours (range, 1 to 2.5 hours). Average blood loss was 528 mL; six of the 10 patients had blood loss less than 250 mL. There were four minor complications and one major complication (gastric ulcer requiring reoperation). There were no deaths in the perioperative period, and no patients required reoperation for hemorrhage.

(Arch Surg. 1990;125:1363-1367)

Author Affiliations
From the Departments of Surgery (Drs Hiatt and Machleder) and Radiology (Dr Gomes), UCLA School of Medicine.

Footnotes
Accepted for publication June 28, 1990.

Read before the 61st Annual Meeting of the Pacific Coast Surgical Association, Laguna Niguel, Calif, February 21, 1990.

Reprint requests to Department of Surgery, Room 8215, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (Dr Hiatt).

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