To evaluate the clinical efficacy of tunnel-building laparoscopic splenectomy (TLS) in the treatment of giant spleen.

Clinical data of 113 patients undergoing single TLS in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2017 to June 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 69 patients were male and 44 female, aged (47±14) years on average. According to the spleen size and weight, all patients were divided into the giant spleen group (n=42) and non-giant spleen group (n=71). Intraoperatively, the retrosplenic tunnel was established through the gap between the posterior and inferior margins of splenic pedicle. The splenic pedicle was initially dissected and subsequently the perisplenic ligament was treated. The perioperative conditions, such as operation time, intraoperative blood loss, spleen extraction time, were statistically compared between two groups by t test. The rate comparison was performed by Chi-square test or Fisher's exact probability test.

All patients completed the operation successfully, and no case was converted to open surgery during the operation. In the giant spleen group, the operation time and spleen extraction time were (83±5) min and (28±5) min, significantly longer than (63±8) min and (15±3) min in the non-giant spleen group (t=17.860, 15.464; P<0.05). No significant difference was observed in the intraoperative blood loss, the first intaking time after surgery, length of postoperative hospital stay and incidence of perioperative complications between two groups (P>0.05).

TLS is not only suitable for routine splenectomy, but also safe and efficacious for giant splenectomy.