Splenectomy: a fifteen years experience of a tertiary center in Turkey

Aim: This study aimed to evaluate the clinical indications, surgical techniques, postoperative complications, and outcomes of patients who underwent splenectomy over a fifteen-year period at a tertiary center in Turkey. Material and Methods: A retrospective review was conducted on 589 patients who underwent splenectomy between January 2008 and July 2022. Demographic data, comorbidities, operative approaches, postoperative complications, and 30-day mortality were recorded. Complications were categorized according to the Clavien-Dindo classification. Results: The median age of patients was 48 years, with males comprising 60.1%. Trauma was the leading indication (27.0%), followed by iatrogenic causes (11.4%), immune thrombocytopenia (9.3%), and secondary malignancies (8.5%). However, the highest mortality rates were observed among patients who underwent splenectomy due to splenic infarction, spontaneous rupture, splenic artery aneurysm, or splenic necrosis. These were followed by higher-risk groups associated with secondary malignancies, iatrogenic injury, and trauma. Open splenectomy was the most performed procedure (77.8%), with higher complication (8.3%) and mortality (17.5%) rates compared to laparoscopic splenectomy (complication: 2.5%, mortality: 1.2%). Overall, 40 patients (6.8%) experienced complications, with Clavien-Dindo Grade 5 events contributing significantly to the 14.3% 30-day mortality rate. Conclusion: This study demonstrated that splenectomy is associated with varying rates of complications and mortality depending on the indication. Trauma was the most common indication, while high-risk conditions such as malignancies and splenic artery aneurysms were associated with poorer outcomes. The lower complication and mortality rates observed with laparoscopic techniques support the potential of minimally invasive or spleen-preserving surgeries to improve patient prognosis.