Surgery Open Surgery(Group 1) Patients were placed in supine position. Since all patients had splenomegaly, preferred incisions were left subcostal. Only three patients requiring synchronous cholecystectomy had upper midline laparotomy incisions (18 cm, 18 cm and 20 cm in length). After routine whole abdominal exploration, with the assistance of abdominal retractors and the first assistance, the inferior pole and medial splenogastric ligament were dissected first, and then the splenorenal ligament and superior pole of the splenophrenic ligament were dissected. The LigaSure vessel sealing system (Valleylab division of Tyco Healthcare, Mansfield, MA) was used for the majority of the dissection. After this, the splenic vascular pedicule was separated from the pancreatic tail with careful dissection. In splenomegaly cases, if the splenic and perisplenic anatomy was appropriate, the ideal ligation of the splenic hilum was outside the abdomen (Figure 1). The splenic artery and splenic vein were ligated with silk (00) and sectioned. In the cases of massive splenomegaly, the main truncus of the splenic artery was ligated before the dissection to minimize blood loss and to allow the return of blood inside the spleen back to the circulation.