Aim: We tried to evaluate the role of preoperative splenic artery embolization (SAE) with hand-assisted 
laparoscopic splenectomy (HALS) in massive splenomegaly. 
Methods: This study was conducted for patients who underwent HALS with preoperative SAE at Surgery 
and Radiology Departments, Minia University Hospital between March 2008 and March 2010. Patients with 
craniocaudal spleen length at least 20 cm on preoperative imaging using ultrasonography were included. 
Data collected included patient characteristics, diagnosis, operative details, conversion to open procedure, 
spleen weight from the pathology report and postoperative complications. The patients underwent 
abdominal ultrasound on postoperative days 7 and 30 to screen for splenic vein thrombosis (SVT) and portal
vein thrombosis (PVT). All patients were followed up for 6 months postoperative. 
Results: Seventeen patients fulfilled criteria for massive splenomegaly. Mean spleen length was 20.4+3.2 cm. 
Mean spleen weight was 1512+15.1. SAE was successfully performed in all patients. Mean operative time 
was 123.2+20.1 min. Mean hospital stay was 2.2+0.4 days. Severe blood loss occurred in one patient (5.9%) 
requiring intraoperative conversion to open splenectomy. Mean blood loss was 214+62.3 ml. Rate of 
postoperative complications was 17.6%. 
Conclusions: HALS after preoperative SAE for massive splenomegaly is feasible, safe procedure reducing 
conversion rate without increasing postoperative morbidity.