From Anatomical Finding to Perioperative Risk Factor: Does Preoperative Splenomegaly Influence Outcomes After Sleeve Gastrectomy? A Single-Center Retrospective Cohort Study

The role of splenomegaly in bariatric surgery remains poorly defined. This study evaluated perioperative outcomes and preoperative laboratory findings in patients with severe obesity and preoperative splenomegaly undergoing sleeve gastrectomy, compared with controls with obesity and without splenic enlargement. Fifty-three patients with ultrasound-confirmed splenomegaly were compared with 54 consecutive controls with obesity. Splenomegaly was graded by cross-sectional area as Grade I (45–59 cm2), Grade II (60–89 cm2), or Grade III (≥90 cm2), and preoperative hematological, coagulation, hepatic, and steatosis-related parameters were assessed. The splenomegaly group included 36 women and 17 men, with a mean age of 35.1 ± 11.1 years and mean BMI of 44.5 ± 5.0 kg/m2; controls were descriptively similar in age, sex distribution, and BMI. Grade I, II, and III splenomegaly accounted for 43.4%, 50.9%, and 5.7% of cases. Abnormal laboratory findings occurred in 37.7% of patients with splenomegaly and 33.3% of controls, with ALT elevation as the most frequent abnormality in both groups. Hepatic steatosis was highly prevalent, no prothrombin activity values below the reference interval were observed among patients, and no prespecified intraoperative or 30-day postoperative complications were documented. In this selected single-center cohort, no excess perioperative morbidity was observed among patients with splenomegaly. These findings do not support treating incidental splenomegaly as an absolute contraindication to sleeve gastrectomy; however, the absence of outcome events and the limited sample size require cautious interpretation, and individualized preoperative hepatic and coagulation assessment remains advisable.