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PubMed2005

Multiple sclerosis following splenectomy as a treatment for idiopathic thrombocytopenic purpura.

A 27-year-old woman was admitted to our hospital with tetraparesis, dysesthesia and hypoesthesia of all regions below the breasts, urinary disturbance, and difficulty in breathing. Since age 21 idiopathic thrombocytopenic purpura (ITP) was diagnosed and steroid therapy was continued. At age 26, she had splenectomy for her ITP. On admission, steroid pulse therapy was administered with a tentative diagnosis of transverse myelitis. Symptoms gradually ameliorated. At age 29, she gradually lost her left vision, and multiple sclerosis was diagnosed and steroid therapy was administered, and her left vision gradually ameliorated. There are several reports describing other autoimmune disorders that arise after splenectomy. Since the spleen acts as a major pool of type 2 helper T cells, it is plausible that peripheral type 1 helper T cell activity may increase after splenectomy, promoting the development of autoimmune disorders. We considered there would be a close relation between splenectomy for ITP and multiple sclerosis in this case.

Adult↗
PubMed1977

The influence of increased hepatic sequestration after splenectomy on the survival and osmotic fragility of red cells in rats, with reference to protein levels in diets.

The sequestration of erythrocytes in rats was studied using an isologous 51Cr-labeled population of either normal or N-ethyl-maleimide (NEM) treated red cells. The spleen sequestered the damaged red cells selectively, while the liver compensated and overshot the sequestration for spleen after splenectomy. The sequestering response in liver increased gradually reaching a maximum level around 8 weeks after splenectomy and then declining toward the control level. These compensatory responses in liver were not observed in rats fed a low-protein diet, which indicated that the proliferative response imposed on liver by an extra work after splenectomy was not stimulated in the rats fed a low-protein diet. Splenectomy prolonged erythrocyte survival and reduced the osmotic fragility of normal red cells, but the compensatory increase in sequestration of damaged red cells in liver did not alter the survival and osmotic fragility of normal red cells of the rat. This fact indicates that the increased sequestration of reticuloendothelial cells in liver is basically reparative, and it is impossible to compensate for the absence of the spleen because of an inability to duplicate certain anatomic features peculiary to the spleen.

Animals↗
PubMed2006

Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices.

AIM: To detect the hemodynamic alterations in collateral circulation before and after combined endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization by ultrasonography, and to evaluate their effect using hemodynamic parameters. METHODS: Forty-three patients with esophageal varices received combined EVL and splenectomy with pericardial devascularization for variceal eradication. The esophageal vein structures and azygos blood flow (AZBF) were detected by endoscopic ultrasonography and color Doppler ultrasound. The recurrence and rebleeding of esophageal varices were followed up. RESULTS: Patients with moderate or severe varices in the esophageal wall and those with severe peri-esophageal collateral vein varices had improvements after treatment, while the percentage of patients with severe para-esophageal collateral vein varices decreased from 54.49% to 2.33%, and the percentage of patients with detectable perforating veins decreased from 79.07% to 4.65% (P < 0.01). Color Doppler flowmetry showed a significant decrease both in AZBF (43.00%, P < 0.05) and in diameter of the azygos vein (28.85%, P < 0.05), while the blood flow rate was unchanged. The recurrence rate of esophageal varices was 2.5% (1/40, mild), while no re-bleeding cases were recorded. CONCLUSION: EVL in combination with splenectomy with pericardial devascularization can block the collateral veins both inside and outside of the esophageal wall, and is more advantagious over splenectomy in combination with pericardial devascularization or EVL in preventing recurrence and re-bleeding of varices.

Adult↗
PubMed2006

Autoimmune thrombocytopenia in response to splenectomy in cirrhotic patients with accompanying hepatitis C.

AIM: To estimate the contribution of autoimmune thrombocytopenia to hepatitis C virus-related liver cirrhosis (type C cirrhosis), we evaluated the influence of splenectomy upon platelet-associated immunoglobulin G (PAIgG) levels and platelet numbers. METHODS: PAIgG titers and immune markers were determined in 24 type C cirrhotic patients with an intact spleen, 17 type C cirrhotic patients submitted to splenectomy, and 21 non-C cirrhosis with an intact spleen. RESULTS: Thrombocytopenia (PLT < 15 x 10(4)/microL) in type C cirrhosis was diagnosed in all patients with an intact spleen, 8 patients submitted to splenectomy, and in 19 non-C cirrhosis with intact spleen. Elevated titers of PAIgG at more than 25.0 ng/10(7) cells were detected in all cirrhotic patients except for one splenectomized patient. PAIgG titers (ng/10(7) cells) were significantly higher in the type C cirrhosis with an intact spleen (247.9+/-197.0) compared with the splenectomized patients (125.6+/-87.8) or non-C cirrhosis (152.4+/-127.4). PAIgG titers were negatively correlated with platelet counts in type C cirrhotic patients with an intact spleen. In comparison with the type C cirrhosis with an intact spleen, the splenectomized patients had a reduced CD4/CD8 ratio and serum neopterin levels. The spleen index (cm2) was negatively correlated with platelet counts in the non-C cirrhosis, but not in the type C cirrhosis. CONCLUSION: Our data indicate that the autoimmune mechanism plays an important role in thrombocytosis complicated by HCV-positive cirrhosis. In addition, splenectomy may impair T cells function through, at least in part, a reduction of CD4/CD8 ratio, consequently suppressing PAIgG production.

Aged↗
PubMed2003

Laparoscopic splenectomy: the latest technical evaluation.

AIM: To introduce our latest innovation on technical manipulation of laparoscopic splenectomy. METHODS: Under general anesthesia and carbon dioxide (CO(2)) pneumoperitoneum, 86 cases of laparoscopic splenectomy (LS) were performed. The patients were placed in three different operative positions: 7 cases in the lithotomic position, 31 cases in the right recumbent position and 48 cases in the right lateral position. An ultrasonic scissors was used to dissect the pancreaticosplenic ligament, the splenocolicum ligament, lienorenal ligament and the lienophrenic ligament, respectively. Lastly, the gastrosplenic ligament and short gastric vessels were dissected. The splenic artery and vein were resected at splenic hilum with Endo-GIA. The impact of different operative positions, spleen size and other events during the operation were studied. RESULTS: The laparoscopic splenectomy was successfully performed on all 86 patients from August 1997 to August 2002. No operative complications, such as peritoneal cavity infection, massive bleeding after operation and adjacent organs injured were observed. There was no death related to the operation. The study showed that different operative positions could significantly influence the manipulation of LS. The right lateral position had more advantages than the lithotomic position and the right recumbent position in LS. CONCLUSION: Most cases of LS could be accomplished successfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.

Adolescent↗
PubMed2005

Anti-infectious prophylaxis after splenectomy: current practice in an eastern region of Switzerland.

Overwhelming post-splenectomy infection (OPSI) is a long-term risk in asplenic patients, which may be minimised by appropriate preventive measures. In this survey anti-infectious strategies after splenectomy were evaluated in an eastern part of Switzerland. We found 91 individuals in the canton of Thurgau, who underwent splenectomy between 1998 and 2003. We assessed adherence to vaccination guidelines, the use of antibiotics and the awareness of the infectious risks by review of hospital charts and by structured interviews with patients and their general practitioners. The total vaccination rate was 64/91 (70%). 6 patients were vaccinated pre-operatively, 50 during the hospital stay and 8 after discharge by the general practitioner. 64 received vaccination against pneumococci, 6 against haemophilus influenzae and 3 against meningococci. Although 39 died during the study period, none died of overwhelming sepsis. None of the patients received a booster vaccination. Prophylactic long-term antibiotics were given to 2 children but to none of the 89 adults. Three adults had a supply of stand-by antibiotics at home. Less than half of the patients who were interviewed knew that asplenia puts them at greater risk for life-threatening infections and few practitioners were aware that travel and animal bites pose a special threat. We conclude that after splenectomy vaccination discipline and patient education should be substantially improved and suggest the publication of comprehensive guidelines.

Adolescent↗
PubMed1975

Sideroblastic anemia with splenic abscess and fatal thromboemboli after splenectomy.

A man with sideroblastic anemia had a splenectomy because of a salmonella abscess of the spleen that had ruptured into the colon. Two months later he developed recurrent thrombophiebitis and fatal thromboembolism associated with thrombocytosis. A review of the literature showed multiple additional cases of sideroblastic anemia with thrombocytosis and thromboembolism after splenectomy. In many of these cases the patient died. Splenectomy for treatment of a sideroblastic anemia probable is contraindicated. If splenectomy is done, long-term therapy to avoid thromboembolic complications probably should be maintained for many months or even years.

Abscess↗
PubMedDate not supplied

Concomitant splenectomy for hypersplenic thrombocytopenia in hepatic resection for hepatocellular carcinoma.

BACKGROUND/AIMS: Resection of hepatocellular carcinoma (HCC) in patients with liver cirrhosis and hypersplenic thrombocytopenia (HSTC) is risky. Controversy exists concerning the role of concomitant splenectomy for HSTC in cirrhotic patients undergoing hepatectomy for HCC. METHODOLOGY: During the past 10 years, 294 patients have undergone hepatic resection for HCC in our department. Among them, 11 cirrhotic patients with severe HSTC (platelet count < or = 80000/mm3) underwent splenectomy simultaneously. The clinical outcomes were retrospectively reviewed. RESULTS: The resected spleen weighed 479 +/- 242 g. The post-operative mortality and morbidity were 9.1% and 27.3%, respectively. In all patients, the platelet count was elevated to above 100000/mm3, and serum total bilirubin was significantly lowered within 1 week of operation. The overall 5-year actuarial and disease-free survival rates were 66.7%. None of the patients developed severe infectious complications during the follow-up period. CONCLUSIONS: Concomitant splenectomy for severe HSTC in cirrhotic patients undergoing hepatectomy for HCC is justified as the benefits of concomitant splenectomy by far surpass the adverse effects.

Aged↗
PubMed1999

[Splenectomy].

The authors ANALYZE the problem of splenectomy from the historical point of view and also the problem of splenectomy indication. Two different periods separated by a short time interval are compared. Recently the indications for splenectomy have changed because of introduction of new drugs in hematologic treatment. The number of "traumatological" splenectomy remains constant. (Tab. 2, Ref. 18.)

Czech Republic↗
PubMed2000

Splenectomy in myelofibrosis with myeloid metaplasia: a single-institution experience with 223 patients.

In a 20-year period, 223 patients (median age, 64.8 years) with myelofibrosis with myeloid metaplasia (MMM) had therapeutic splenectomy at our institution. Primary indications for surgery were transfusion-dependent anemia (45.3%), symptomatic splenomegaly (39. 0%), portal hypertension (10.8%), and severe thrombocytopenia (4.9%). Operative mortality and morbidity rates were 9% and 31%, respectively. The 203 survivors of surgery had a median postsplenectomy survival time (PSS) of 27 months (range, 0-155). Among preoperative variables, thrombocytopenia (platelet count less than 100 x 10(9/)L) and nonhypercellular bone marrow were identified as independent risk factors for decreased PSS. Durable remissions in constitutional symptoms, transfusion-dependent anemia, portal hypertension, and severe thrombocytopenia were achieved in 67%, 23%, 50%, and 0% of the patients, respectively. Histologic or cytogenetic features of bone marrow obtained before splenectomy did not predict a response in cytopenias. After splenectomy, substantial enlargement of the liver and marked thrombocytosis occurred in 16.1% and 22.0% of the patients, respectively. The thrombocytosis was associated with an increased risk of perioperative thrombosis and decreased PSS. The rate of blast transformation (BT) was 16.3%, and the risk of BT was higher in the presence of increased spleen mass and preoperative thrombocytopenia. However, the PSS of patients with BT was not significantly different from that of patients without BT. We conclude that presplenectomy thrombocytopenia in MMM may be a surrogate for advanced disease and is associated with an increased risk of BT and inferior PSS. However, the development of BT after splenectomy may not affect overall survival and does not undermine the palliative role of the procedure for the other indications.

Adolescent↗
PubMed1999

Combined laparoscopic splenectomy and cholecystectomy for the treatment of hereditary spherocytosis: is it safe and effective?

Hereditary spherocytosis is the most common red blood cell membrane disorder and often is associated with hemolytic crisis and premature cholelithiasis. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Laparoscopic cholecystectomy and splenectomy have been performed safely worldwide. We report our experience with seven patients (one male and six female, average age 12 years) who underwent combined laparoscopic splenectomy and cholecystectomy for hereditary spherocytosis. The patient was placed in supine position and the procedure performed with a five-trocar technique. Cholecystectomy was performed first, then splenectomy was achieved and the spleen removed by morcellation into a retrieval bag (five cases) or via a 4- to 5-cm left subcostal incision (two cases). No patient required conversion to open technique or blood transfusion. The mean blood loss was 162 mL, mean operative time 207 minutes, mean spleen size 14.5 cm, and median postoperative hospital stay 4 days. No perioperative mortality or major complications occurred in our series. After a median follow-up of 18 months all patients showed sharp hematologic improvement. Despite the small number of cases, we consider the combined laparoscopic approach safe and effective for the treatment of hereditary spherocytosis.

Child↗
PubMed2000

Pediatric laparoscopic splenectomy.

BACKGROUND: Lateral laparoscopic splenectomy in adults, first reported in 1991, was begun with children in 1993. METHODS: The authors reviewed records of 59 patients 2 to 17 years old who underwent laparoscopic splenectomy by the lateral approach between 1994 and 1998 at four medical centers. Patients received prophylactic penicillin or vaccinations preoperatively. RESULTS: Of the 59 patients, 51 required splenectomy for one of the following conditions: idiopathic thrombocytopenic purpura, hereditary spherocytosis, or sickle-cell disease. Splenomegaly was found in 86% of the patients, and ten accessory spleens were resected. No deaths or infection occurred, and only three patients had perioperative complications: acute chest crisis, small diaphragmatic injury, and intraoperative hemorrhage. One operation was converted to a minilaparatomy because of difficulty with specimen extraction. CONCLUSIONS: Pediatric laparoscopic splenectomy is safe and effective, resulting in little blood loss, rapid recovery, and a good cosmetic outcome.

Adolescent↗
PubMedDate not supplied

Laparoscopic splenectomy in pediatric patients with hematologic diseases.

OBJECTIVE: The aim of this study was to evaluate our experience with laparoscopic splenectomy in pediatric patients with hematologic diseases. METHODS: A retrospective chart review was performed to analyze the following: indication for splenectomy, pre- and peri-operative management, surgical technique, complications, duration of hospitalization, and outcome. RESULTS: Eleven patients underwent laparoscopic splenectomy for the following indications: recurrent thrombocytopenia (<10,000) in seven with chronic immune thrombocytopenic purpura; anemia in two with hereditary spherocytosis; and hypersplenism in one and recurrent splenic sequestration in another with homozygous hemoglobin S. The six girls and five boys had a median age of 7 years. The median operative time was 180 minutes, and the median hospitalization was 72 hours. Among the patients with immune thrombocytopenic purpura (median platelet count, 153,000), those patients (n=3) with platelet counts of <100,000 did not suffer any bleeding complications. The patient with hypersplenism and homozygous hemoglobin S required a small incision in the left lower quadrant to facilitate removal of a 558-gram spleen. This patient also underwent cholecystectomy for cholelithiasis. The operative time was 295 minutes, and he was hospitalized for 5 days because of atelectasis. CONCLUSIONS: Laparoscopic splenectomy is a safe and effective procedure in children with hematological disorders.

Adolescent↗
PubMedDate not supplied

[Splenectomy in the treatment of hematologic diseases].

After first splenectomy performed 1888 for spherocytosis until now, a number of hematological indications for therapeutical splenectomy were described, with established preoperative treatment and more favorable postoperative results in recent studies. In the period between 1985 and 1997, 130 splenectomies for hematological disorders were performed on Department of surgical gastroenterology, 1st Surgical Clinic. The indications were as follows: 72 patients with autoimmune hematological diseases (55.38%), 28 patients with lymphoproliferative diseases (21.54%), Hodgkin-s disease in 11 patients (8.46%), myeloproliferative diseases in 6 (4.62%), splenectomy as a part of staging laparotomy in patients (7.69%), and for other hematological disorders in 3 patients (2.31%). Most of the removed spleens (95) weighted from 500 to 1500 g (73.08%). In 19 patients spleens weighted less then 500 g (14.62%), and in 16 patients more then 1500 g (12.31%). There was no significant correlation between the weight of the removed spleen and the incidence of postoperative complications. In 8 patients with preoperative thrombocytopenia (6.16%), intraoperative infusions of fresh thrombocytes were used. In 12 patients (9.23%) postoperative complications occurred, mainly in the patients who received immunosuppressive therapy preoperatively in excessive amounts, and were disease-dependent. Overall mortality was 4 (3.12%), and in 2 patients there was "exitus in tabular". Delayed results depended of basic hematological disorder and supportive treatment. The surgical particularities of the operative procedure are discussed, as well as the perioperative treatment and certain aspects of teamwork of hematologist and surgeon.

Adolescent↗
PubMedDate not supplied

[Effectiveness of partial splenectomy in the treatment of hereditary spherocytosis].

OBJECTIVES: To evaluate the hematological and clinical response to partial splenectomy in a group of children with hereditary spherocytosis. MATERIAL AND METHODS: We analyzed the main hematological and clinical features in 13 patients with hereditary spherocytosis submitted to partial splenectomy. The diagnosis of the disease and the hematological studies was made according to standard methods. To establish the inheritance pattern we also studied both parents. During the surgical procedure the upper two thirds of the spleen were removed and the lower pole was preserved. We use prophylactic penicillin (250 mg twice a day) during 3 years. RESULTS: The diagnosis of the disease was made during the first year of life in 11 patients, 76.9% had neonatal hyperbilirrubinemia, 53.8% showed hepatomegaly and in 69.2% we observed splenomegaly. 84.6% received blood transfusion. The hemoglobin level was significantly increased (p = 0.04) and the reticulocytes significantly diminished (p = 0.01) after splenectomy. No hemolytic crises, blood cell transfusion requirement neither infection was observed after surgery. CONCLUSIONS: Although the number of patients and the post-surgical follow-up is reduced, the hematological recovery observed in our cases suggest that partial splenectomy is a beneficial surgical procedure for the treatment of the typical and severe form of hereditary spherocytosis.

Adolescent↗
PubMed2001

[Laparoscopic splenectomy in pediatric hematologic diseases].

INTRODUCTION: Surgical acceptance of the laparoscopic splenectomy in the pediatric hematological disorders has improved due to safety, to relif postoperative pain, and to reduce the hospital stay. The aim of this study is present our surgical laparoscopic technique performed. MATERIAL AND METHODS: Eight patients, 6 spherocytosis (age ranged: 6-14 years, average age: 9.5 years; 5 girls and 1 boy) and 2 cases of autoimmune hemolytic anemia (both boys of 18 months and 4 years) underwent laparoscopic splenectomy. The Trias-Targarona technique has been performed placing the patient at the right lateral-decubitus position. Four trocars are placed, two of 5 mm in the posterior axillary line and epigastrium and other 2 trocars of 12 mm, in the middle of them. RESULTS: In all these 8 patients a laparoscopic splenectomy was completely performed. We had 2 cases with problems with the sac introduction. Cosmetic results have been excellent and we changed the 7-day antibiotic protocol for 2-day protocol. The surgical time has changed from 3 to 2 hours. CONCLUSIONS: With laparoscopic splenectomy we can give an adequate response to hematological disorders in children with a acceptable surgical time, an excellent cosmetic result with a minimum postoperative time and a very short hospital stay.

Adolescent↗
PubMedDate not supplied

Predictors for morbidity and mortality following non-traumatic splenectomy at the University Hospital, Jeddah, Saudi Arabia.

OBJECTIVE: To determine the pre-operative predictors of morbidity and mortality of patients undergoing elective splenectomy for non-trauma indications. METHODS: Analysis of 123 patients who underwent splenectomy at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 1986-1996. Data collected included patients' demographic data, indication for splenectomy, laboratory data, details of operative procedure and postoperative events for morbidity and mortality. Statistical analysis was carried out using the Chi-square test. RESULTS: Of the patients, 69% were males and 31% females with ages ranging from 13-72 years (mean 39 years). Portal hypertension constituted 55% of the indications and benign hematological conditions 26%. The morbidity rate was 27.6% and the commonest complication was chest and wound infection in 6.6% and 5.7%, respectively. Age of >50 years, pre- and postoperative haematocrit of <33%, thoraco-abdominal approach and operative time of >120 min had P values of < 0.05, <0.002, <0.03 and <0.03, respectively for postsplenectomy mortality. CONCLUSIONS: According to this study, age of >50 years is a significant predictor for morbidity following splenectomy, whereas age >50 years, pre- and postoperative haematocrit of <33%, thoraco-abdominal approach and operative duration >120 min were significant predictors of postsplenectomy mortality.

Adolescent↗
PubMed1998

[Clinical observation of splenectomy on chronic idiopathic thrombocytopenic purpura in 63 patients].

OBJECTIVES: To investigate the effectiveness of splenectomy in patients with idiopathic thrombocytopenic purpura who failed to respond to conservative management. METHOD: Sixty-three patients were treated with splenectomy and followed up for 2 months to 16 years (average 4.7 years). RESULT: The patients had symptoms of bleeding and their platelet count on average was 24 x 10(9)/L. The first, 3rd, 5th and 7th day after operation, the average platelet count was 110 x 10(9)/L, 202 x 10(9)/L, 251 x 10(9)/L and 246 x 10(9)/L. Their platelet recovered to normal during a week in 51 cases (80.9%). The total effective rate was 86.9% after follow-up for 2 months. The recurrence rate was 17.9% in 39 cases after follow-up for longtime. CONCLUSIONS: The curative effect of splenectomy is better in children than in adults. In patients with increased platelet have a favourable prognosis. Splenectomy is safe and effective in the treatment of idiopathic thrombocytopenic purpura.

Adolescent↗