Not all splenomegaly requires surgical removal, but those with indications for surgery include: (1) intrahepatic portal hypertension combined with hypersplenism, extrahepatic portal hypertension such as splenic aneurysm, splenic arteriovenous fistula and splenic vein thrombosis causing congestive splenomegaly; (2) primary tumors of the spleen; (3) splenic cysts; (4) hypersplenism, such as primary thrombocytopenic purpura, congenital hemolytic anemia, primary splenic neutropenia, primary allohemocytopenia, acquired hemolytic anemia, etc. When patients with splenomegaly, first of all, they should take into account their symptoms and their signs, actively search for the primary disease, and the treatment should be directed at the primary disease. Commonly used conservative treatments include: eat less food that is not digestible, eat less spicy things, such as chili, garlic, onion, etc., do not drink alcohol, do not eat too much at night, and eat a light diet. And with the active treatment of Chinese medicine; usually do more soothing exercise, as little as possible to do strenuous exercise. In the following cases, conservative treatment should be abandoned and surgery should be actively prepared: significant splenomegaly with symptoms of compression; severe hemolytic anemia; severe reduction of granulocytes and frequent infection; significant reduction of platelets, or with bleeding manifestations, etc. How traumatic is splenectomy In classical splenectomy, an oblique incision under the left upper abdominal rib cage or a median incision in the upper abdomen is made, and the spleen is removed under direct vision after entering the abdomen layer by layer. Due to the long incision and large incision, the patient is more traumatized and therefore has a slower postoperative recovery. For this reason, minimally invasive techniques, represented by laparoscopy, have been introduced and are now maturing for splenectomy. Compared with traditional transabdominal surgery, laparoscopic splenectomy has significant advantages: (1) the incision is small and beautiful, the incision infection and incisional hernia incidence is very low, almost no bleeding, and no blood transfusion is needed; (2) the laparoscopic field of view is open and clear, and has a field of view that transabdominal surgery does not have. (3) The laparoscope can reach the narrow space around the spleen, magnify the local view, and deal with the splenic colon ligament, splenogastric ligament, splenodiaphragmatic ligament and splenorenal ligament, which are simpler and easier to perform than transabdominal surgery. (4) The postoperative pain is light and facilitates early activity, and patients can generally get out of bed within one or two days after surgery, which is conducive to promoting the recovery of postoperative gastrointestinal function, so patients can eat earlier; (5) There is no pain caused by the large incision after transabdominal surgery, which facilitates deep breathing and coughing up sputum, minimizing the incidence of atelectasis and pulmonary infection, so this minimally invasive surgery is especially suitable for elderly and frail patients; (6) The hospitalization is easy and convenient, which makes laparoscopic splenectomy more convenient than transabdominal surgery. Therefore, this minimally invasive surgery is especially suitable for elderly and frail patients; (6) the hospitalization time is significantly shortened. Patients with giant spleen treated by our minimally invasive procedure usually have a hospital stay of 3-5 days, which is much less than the original open treatment. Of course, not all enlarged spleens can be removed by minimally invasive means. In a small number of patients with portal hypertension and giant spleen, the increased number of collateral circulation vessels around the spleen, varicose veins, and the thin and easily torn walls of the venous vessels, as well as the narrow operating space in the abdominal cavity due to the giant spleen, can easily damage the angry veins during the laparoscopic splenectomy operation and lead to hemorrhage. This may lead to transabdominal surgery in this group of patients. To avoid this as much as possible, I use hand-assisted laparoscopic splenectomy: a separate incision is made in the abdominal wall to accommodate one hand, and a hand is inserted to guide the laparoscopic instruments, which allows for more precise management of the adhesions and large varicose vessels around the spleen, thus reducing the likelihood of conversion to transabdominal surgery. Even with this additional incision, the incision is still significantly smaller than that of open surgery. Above: Spleen cut by laparoscopic surgery Above: Spleen cut by laparoscopic surgery Above: Size of incision after laparoscopic surgery Expert Profile Sun Xing, MD, PhD, Professor, Doctoral Supervisor, Chief Physician, Department of General Surgery, The First People’s Hospital of Shanghai Jiaotong University, and Reviewer of National Natural Science Foundation of China. He specializes in surgical treatment of complex hepatobiliary, pancreatic and splenic tumors, in situ liver transplantation and biliary tract reconstruction. In recent years, he has concentrated on minimally invasive treatment of hepatobiliary, pancreatic and splenic surgery, laparoscopic resection of liver, spleen and pancreatic tumors, and systematic treatment of complex cholelithiasis with double-scope combination and triple-scope combination, etc. He has accumulated rich experience and innovation. He received the first prize of Shanghai Science and Technology Progress Award in 2006 and the first prize of Science and Technology Progress Award for Higher Education Institutions of the Ministry of Education of China in 2007, three National Natural Science Foundation of China and one international exchange project from 2009 to 2013. At present, he has undertaken four national projects and two Shanghai-level projects, and has published more than 30 papers, including 10 SCI papers. 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