Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Splenectomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
PubMedDate not supplied

Role of splenectomy in living-donor liver transplantation for adults.

BACKGROUND/AIMS: Splenectomy is occasionally required in liver transplantation. However, its indications and drawbacks have not been clearly defined in living-donor liver transplantation. METHODOLOGY: Eleven of 59 adult living-donor liver transplantation recipients underwent splenectomy. Indications were thrombocytopenia in 6 cases, portal flow disturbances due to splenorenal shunt in four, and splenic infarction in one. The incidence of bacterial complications and changes in platelet counts and portal vein flow were evaluated. RESULTS: Two patients died of pneumonia and cerebral bleeding, respectively. Six events of bacterial infections occurred in the remaining nine patients. After splenectomy, a normal portal flow was achieved and the platelet count significantly increased. CONCLUSIONS: Splenectomy may be an acceptable option in patients with thrombocytopenia or when it is necessary to change the portal flow.

Adult↗
PubMedDate not supplied

Splenectomy, chemically-induced mammary tumors and parathymic lymph nodes in rats: experimental and morphological studies.

The objective of this study was to examine whether splenectomy alters the tumorigenic response of rats to chemically-induced mammary tumors and to determine the role played by the parathymic lymph nodes (PTLN) in the antitumor immune response. Female rats were splenectomized and then exposed to 9,10-dimethyl-1,2-benz(a)anthracene (DMBA) to induce mammary tumors. Splenectomy decreased the rate of tumor appearance. The latent period for appearance of the first tumors in splenectomized rats was 12.0 +/- 0.9 week compared to 9.7 +/- 0.5 week in intact controls. The latent periods for appearance of all tumors including those with malignancy were similar for both rat groups. Splenectomy caused a significant increase in the size of the PTLN as well as changes in their structure. The cortex became thick, better formed and enriched with lymph elements of follicles and a wide venous net. CD8+ cells infiltrated the paracortex whereas CD4+ cells were located around the blood vessels. In conclusion, splenectomy inhibits the early stages of tumorigenesis, but does not prevent the progress of carcinogenesis. Different responses of splenectomized (operated) and intact rats to the effect of DMBA can be explained by an increase in the nonspecific resistance of splenectomized rats as a result of the operation. PTLN actively participate in this compensatory reaction of the immune system of animals.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed2002

Gamma probe-confirmed laparoscopic accessory splenectomy.

The simultaneous occurrence of idiopathic thrombocytopenic purpura (ITP) and Hodgkin's disease in the same patient is uncommon. There have been only a limited number of reported cases of newly diagnosed ITP following Hodgkin's disease. Even more uncommon is the development of ITP after splenectomy for Hodgkin's disease. Of the reported cases of ITP following splenectomy for Hodgkin's disease, all have been successfully treated with medical therapy. We report an unusual case of an accessory spleen causing ITP in a patient who had undergone a splenectomy for Hodgkin's disease 10 years earlier. The patient underwent hand-held gamma-probe-assisted laparoscopic accessory splenectomy.

Adult↗
PubMed1976

Effect of splenectomy on tolerance to combination chemotherapy in patients with lymphoma.

Enhanced tolerance to combination chemotherapy has been cited as an ancillary benefit of staging laparotomy and splenectomy in Hodgkin's disease. Seventeen patients with Hodgkin's disease and 15 with non-Hodgkin's lymphoma were subjected to nontherapeutic splenectomy as part of the staging procedure prior to their initial treatment with MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) or CVP (cyclophosphamide, vincristine, and prednisone) chemotherapy, respectively. Matched control patients of comparable age, pathologically proven stage, and presence or absence of bone marrow lymphoma and previous radiotherapy were selected. Although leukocyte (in non-Hodgkin's patients) and platelet counts (in both groups) were significantly higher in the patients with splenectomy during most of the first six cycles of therapy, there was no difference in the number of cycles during which a leukocyte count below 1000 (or below 2000 in Hodgkin's disease) or platelet count below 50,000 was recorded in the splenectomized and control patients. The total dose of all drugs actually delivered, time required to complete six cycles of treatment, and the portion of patients entering complete remission were not significantly different in the two groups. We have found no evidence that splenectomy per se, in lymphoma patients without findings of hypersplenism, improves the ability to administer planned amounts of drugs during initial combination chemotherapy.

Cyclophosphamide↗
PubMed2003

[Laparoscopic and open splenectomy for idiopathic thrombocytopenic purpura].

Idiopathic thrombocytopenic purpura(ITP) is an immune disorder, which causes an acute or chronic thrombocytopenia, and may result in potentially life-threatening hemorrhage. Splenectomy is one of the treatment options that needs to be weighted in the treatment of ITP, particularly in cases that have shown response failure to medical modalities such as prednisone, or anti-D globulin therapy. However, because open splenectomy (OS) requires more surgical invasiveness, surgical treatment had not been accepted for many patients with ITP. Recently, laparoscopic splenectomy(LS) is being accepted as an effective alternative to OS in treating ITP. The most important parts of this method are, mobilization of the spleen by dissection of the splenic ligament, and the blocking of blood circulation to the spleen by division of the hilar arteries and veins. The procedure is as follows: (1) The patient is in a right lateral decubitus position. (2) The resection of the splenic ligament is made by an ultrasonic coagulating dissector. (3) The splenic hilum is dissected with an auto-stapler. (4) The freed spleen is contained in a nylon bag and extracted. Laparoscopic splenectomy is a feasible and safe for patients with ITP.

Humans↗
PubMed2003

Laparoscopic adrenalectomy and splenectomy are safe and reduce hospital stay and charges.

The proposed benefits of laparoscopy for certain surgical procedures have been decreased post-operative pain and hospital stay balanced against the proposed deficits of increased costs. We have reviewed our data to evaluate factors associated with patient, procedure, and hospital charges for patients undergoing open versus laparoscopic adrenalectomy and splenectomy during the same time period. Eighty-seven patients underwent adrenalectomy (n = 47) or splenectomy (n = 40) from October 30, 1995 to June 6, 2001 and were retrospectively reviewed. Patient and operative factors were analyzed by intent to treat; the major endpoints were operating room (OR) time in minutes, blood loss in cm3, length of hospital stay in days, and charges broken down by anesthesia/operation [OR/recovery room (RR)] and total charges in dollars x 1000. Comparisons of means were analyzed by unpaired t test; data are presented as mean +/- SEM, and significance is defined as P < 0.05. Median age of the group was 47 years (range 20-77). Forty-five patients underwent a laparoscopic approach of which two were converted to open (4%) as compared with 42 undergoing an open operation; one patient from each group was excluded from outcome analyses because of prolonged hospitalization (>3 weeks). Operative mortality of the whole group was one per cent. There were no differences between the groups with respect to age, gender, or comorbidity. The laparoscopic group had significantly longer operative times and OR/RR charges. However, the length of hospital stay and the total charges for the patient undergoing a laparoscopic approach were significantly less (P < 0.05). We conclude that a laparoscopic approach for adrenalectomy or splenectomy can be accomplished in approximately 95 per cent of patients selected for this procedure. Despite prolonged OR time and increased OR/RR charges the laparoscopic procedures resulted in significantly decreased length of hospital stay and overall patient charges. Laparoscopy is a safe and cost-effective approach and should be strongly considered in patients requiring adrenalectomy or splenectomy.

Adrenalectomy↗
PubMed1977

Time dependence of the effect of splenectomy on graft-versus-host reactivity of lymph node cells.

Changes in cell-mediated reactivity of lymph node cells at various intervals after splenectomy were investigated in three assays measuring the GVH reactivity of parental cells in F1 hybrids --splenomegaly test in very young recipients and popliteal lymph node enlargement assay in adults measuring the proliferative component of the reaction, and mortality assay in sublethally irradiated recipients measuring the killer activity of the cell inoculum. During the early postsplenectomy period the reactivity of the particular amounts of lymph node cells was lower than that of cells from normal donors, but at about 3 weeks after splenectomy it was higher. The increase was of short duration in the proliferation assay and at 5 weeks the reactivity declined markedly below the control values. The increase in activity persisted for 5 weeks after splenectomy in the "killer" assay. It is probable that the described changes in cell-mediated reactivity are involved in the total effect of splenectomy on the host's complex immune response, especially against normal and tumour allografts.

Animals↗
PubMed1992

Effects of splenectomy on immune thrombocytopenic purpura in (NZW x BXSB) F1 mice: analyses of platelet kinetics and anti-platelet antibody production.

Effects of splenectomy on platelet kinetics and production of anti-platelet antibodies were studied in male (NZW x BXSB) F1 (W/B F1) mice, which are known as the animal model of immune thrombocytopenic purpura (ITP). Studies on organ localization of radiolabeled platelets revealed that splenic uptake significantly increases in W/B F1 mice in comparison with that of normal controls. W/B F1 mice showed a significant increase in platelet counts and, in contrast with sham-operated controls, high levels of platelet counts were maintained up to 6 weeks after splenectomy. Platelet lifespans (PLSs) did not reach normal levels, although prolonged PLSs were observed. In addition, platelet-associated antibody (PAA) values showed a tendency towards transient decrease, but there was no change in platelet-bindable serum antibodies (PBAs). These findings indicate that the suppression of anti-platelet antibody production is essential to the treatment of ITP; splenectomy may not be effective in treating severely affected ITP patients because, although the spleen is one of the major sites of platelet sequestration and antibody production, reticulo-endothelial systems (RESs) (liver, bone marrow, lymphnodes, etc.) other than the spleen are also responsible for the destruction of platelets. We therefore consider the W/B F1 mouse to be a useful model of human ITP, and believe that it provides valuable information for the development of new therapeutic agents in patients with ITP, especially those who do not respond to splenectomy.

Animals↗
PubMed1992

Response to plasma exchange and splenectomy in thrombotic thrombocytopenic purpura. A 10-year experience at a single institution.

BACKGROUND: This study was designed to assess the response of patients with thrombotic thrombocytopenic purpura to plasma exchange and to evaluate the role of splenectomy after relapse. METHODS: The records of all patients with thrombotic thrombocytopenic purpura who had plasma exchange as primary treatment at a single center during a 10-year period were retrospectively reviewed. Response to the initial course of plasma exchange was determined, and the clinical outcome was evaluated in patients whose conditions were either refractory to exchange, responded without relapse, or relapsed after initial response. The outcome of patients treated during relapse with splenectomy was evaluated. A literature review was conducted to determine the clinical outcome in patients treated similarly. RESULTS: Twenty-seven patients for whom data could be evaluated had been treated in the 10-year period. Twenty-one (78%) responded to the plasma exchange, but the conditions of six (22%) were refractory and these patients died. Eight patients (30%) had one or multiple relapses after initial response but had prolonged remissions after additional plasma exchange alone (two patients) or splenectomy (six patients). A review of 19 reports, including 224 patients with thrombotic thrombocytopenic purpura initially treated with plasma exchange, revealed similar findings, with initial response in 81%, refractoriness in 19%, and relapse after initial response in 27% of patients. CONCLUSION: Response to plasma exchange in thrombotic thrombocytopenic purpura is associated with an excellent prognosis, and most deaths occur in patients whose conditions are refractory. Relapses after initial response are frequent but can be managed successfully with additional plasma exchange or with splenectomy, which often induces long-term remissions.

Adult↗
PubMedDate not supplied

Splenectomy for hematological disorders in the Eastern Province of Saudi Arabia.

Splenomegaly is a common clinical disorder in the Kingdom of Saudi Arabia. Its aetiology is variable and includes portal hypertension due to schistosomal periportal hepatic fibrosis, haemoglobinopathies and lymphoproliferative disorders. At King Fahd Hospital of the University, Al-Khobar in the Eastern Province of the Kingdom, splenectomy is performed frequently for various reasons on patients drawn from all the Provinces. This is a report of 104 patients (age range eight months to 65 years) who underwent splenectomy between 1982 and 1987. We reviewed the indications, operative findings, outcome, and complications of the procedure. Patients with hypersplenism formed the largest group (50%) subjected to splenectomy followed by those suffering from the haemoglobinopathies. Chest infection as the most common complication and it mainly affected patients with portal hypertension. Post-operative septicaemia occurred in four cases within six months from the date of splenectomy.

Adolescent↗
PubMed1992

[Clinical aspects, pathophysiology, therapy and expert evaluation of splenectomy].

Splenectomy increases on principle and for life the risk to die of a foudroyant postsplenectomy infection, the so called OPSI-syndrome. The main factors determining the frequency of the OPSI-syndrome are the age at time of operation and the indication for splenectomy. Postsplenectomy infection is mostly caused by pneumococci. In general the important pathophysiological factors are a lack of filtration capacity, a decreased opsonisation activity and a deficiency of early immunoglobulin production. The increased risk of children is probably caused by a physiologically reduced immune response and a cumulation of primary infections. In the foudroyant course of postsplenectomy infection therapy is mostly taken not in time, and mortality ranges between 50 and 80%. For this reason it is necessary to stress prophylaxis as: antibiotics, vaccination, autotransplantation and preserving surgery. The effectivity and application of these prophylactic measurements are clearly limited. Therefore it is very important to inform all patients and their parents about the low, but lifelong risk of infection following splenectomy in order to begin the antibiotic therapy as soon as possible even in cases of banal infections. In expert opinion about the loss of spleen the real situation of the splenectomized individual has to be regarded in making very precise analysis of the course of disease. This has to be done in considering the branch of insurance ordering the opinion (legal accident insurance, legal pensions insurance, social compensation law, private accident or life insurance). If infections or other illness often appear after splenectomy, these have to recognized as resulting impairment, provided that other causes have been excluded. In uncomplicated course it is not justified to suppose disability only by immanent risk.

Expert Testimony↗
PubMedDate not supplied

Portal vein thrombosis after laparoscopic splenectomy: an ongoing clinical challenge.

OBJECTIVES: Portal vein thrombosis (PVT) following open splenectomy is a potentially lethal complication with an incidence of up to 6%. The objective of this report is to describe our management of a recent laparoscopic case, discuss current therapies, and consider antiplatelet therapy for prophylaxis. METHODS: Medical records, laboratory studies, and imaging studies pertaining to a recent case of a laparoscopic splenectomy were examined. Current literature related to this topic was reviewed. RESULTS: A 16-year-old girl underwent laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Her preoperative platelet count was 96K. She was discharged on postoperative day 1 after an uneventful operation including division of the splenic hilum with an endoscopic linear stapler. On postoperative day 20, she presented with a 5-day history of epigastric pain, nausea, and low-grade fevers without peritoneal signs. Her white blood cell count was 17.3; her platelets were 476K. Computed tomography demonstrated thrombosis of the splenic, superior mesenteric, and portal veins propagating into the liver. Heparinization was begun followed by an unsuccessful attempt at pharmacologic and mechanical thrombolysis by interventional radiology. Over the next 5 days, her pain resolved, she tolerated a full diet, was converted to oral anticoagulation and sent home. Follow-up radiographic studies demonstrated the development of venous collaterals and cavernous transformation of the portal vein. DISCUSSION: No standard therapy for PVT exists; several approaches have been described. These include systemic anticoagulation, systemic or regional medical thrombolysis, mechanical thrombolysis, and surgical thrombectomy. Unanswered questions exist about the most effective acute therapy, duration of anticoagulation, and the potential efficacy of routine prophylaxis with perioperative antiplatelet agents. PVT following splenectomy occurs with both the open and laparoscopic approach.

Adolescent↗
PubMed2005

[Splenectomy in hematologic diseases. A study of 70 cases].

The aim of this work was to report our own clinical experience and to compare it our results with those already published. This is a retrospective study of 70 splenectomies performed for hematologic diseases at the service des urgences viscerales of Ibn Rochd teaching hospital of Casablanca, between 1996 and 2001. The study included 70 patients. Splenectomy was performed for therapeutic reasons by laparotomy in 56 cases (80%) and bym laparoscopy in 14 cases (20%). The post-operative after-effects were mild in 81.4%. A patient died, however of pulmonary embolism. Splenectomy is an important tool in the management of patients suffering from hemolytic anemia, auto-immune thrombopenic purpura and other hemolytic anemias. Management by a multidisciplinary team is required to prevent a maximum of long and short-term post-operative complications and to offer the offer the best conditions for a successful splenectomy.

Adolescent↗
PubMed2005

Incidence of portal vein thrombosis after laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy has become an important therapeutic option in the management of diverse hematologic disorders. However, the incidence of important complications, such as portal vein thrombosis, remains poorly understood. We set out to study the incidence of this complication over a 14-month period. METHODS: All adult patients who underwent laparoscopic splenectomy between July 2001 and April 2002 at McMaster University Medical Centre in Hamilton, Ont., were approached postoperatively and offered duplex ultrasonography of the portal vein to look for thrombosis. RESULTS: During the study period 17 patients underwent laparoscopic splenectomy. Two patients declined to participate, and in 1 patient the ultrasonography was technically inadequate. Of the 14 remaining patients, 2 (14%) were found to have portal vein thrombosis. In 1 other patient, the investigation was suggestive, but not conclusive, of a clot in the portal system. CONCLUSIONS: Portal vein thrombosis in this series was a relatively common complication of laparoscopic splenectomy. Further research is needed to confirm our findings.

Adult↗
PubMed2003

[Laparoscopic splenectomy, is it the gold standard?].

BACKGROUND: At the beginning of the last decade, different groups of workers developed almost simultaneously the laparoscopic splenectomy technique. From then on, and based on the accumulated experience done in the field, this technique has become the preferred approach. OBJECTIVES: to analyze the results obtained with laparoscopic splenectomy on 29 patients with various pathologies. LOCATION: General Surgery Service Number 2, Prof. Pablo Mirizzi, Clinic National Hospital. General Surgery Service, Sucre Clinic, Córdoba. DESIGN: prospective study. MATERIALS AND METHODS: Twenty-nine laparoscopic splenectomies were indicated in 22 cases of idiopatic thrombocytopenic purpura, 4 autoimmune hemolytic anemia, two spheroid and one segmental hypertension portal. A simultaneous prophylactic cholecistectomy was performed in cases of malign spheroid associated with cholelitiasis. Cases of incorrigible coagulopaty, ascitis and spleenomegaly, greater than 30 cm., were discarded. Antibiotic prophylaxis, bovine anti-pneumonic vaccine, drainage to the spleen cavity, precocious mobilization and liquid diet starting at 6 a.m. were systematically indicated. RESULTS: there was no mortality and a patient with spleenomegaly of 28 cm. was converted (3.4%). The average surgical time was 90 minutes. In 4 cases (13.7%) of patients with ITP, accessory spleens were found. No patient was transfused when bleeding was less than approximiately 100cm. The main surgical difficulty was the spleen mobilization at the level of the pedicle in the big spleens and the hemorrhaging in small volumes during the dissection. CONCLUSION: this technique offers a series of advantages that allow it to be considered as the new "gold standard" for splenectomy.

Adolescent↗
PubMed2006

[Effects of splenectomy on patients undergoing liver transplantation].

OBJECTIVE: To investigate the effects of splenectomy before or simultaneously in liver transplantation on the outcome of liver transplantation. METHODS: Splenectomy was performed on 29 of the consecutive 403 patients undergoing orthotopic liver transplantation (OLT) between February 1999 and May 2005, before the OTC in 23 of which and simultaneously during the OTC in 6 of which. Fifty-eight randomized selected age-matched patients undergoing OTC within the same period but without splenectomy were used as controls. The operation time, bleeding amount, transfusion amount, infection, acute rejection, survival rate, and post-operative recovery of platelet were compared between these groups. RESULTS: The average operation times of the pre-operatively splenectomized group (Group A) and intra-operatively splenectomized group (Group B) were 448.70 +/- 100.51 minutes and 526.67 +/- 99.93 minutes respectively, both significantly longer than that of the non-splenectomized group (Group C) (362.80 +/- 71.65 minutes, both P < 0.001). The intra-operative bleeding amount of the 2 splenectomized groups were both longer than that of the control group, however, not significantly. The intra-operative transfusion amounts of Group B was 3983 +/- 1885 ml, significantly more than that of Group C (2361 +/- 1246 ml, P < 0.05). The plasma transfusion amount of Group B was 8387 +/- 4231 ml, significantly more than that of Group C (4906 +/- 3108 ml, P < 0.05). The concentrated erythrocyte transfusion amount of Group A was 14.2 +/- 14.6 U, significantly more than that of Group C (5.1 +/- 6.6 U, P < 0.001). The bacterial infection rates of the Groups A and B were 91.3% and 100% respectively, both significantly higher than that of Group C (69.0%, both P < 0.05). The mycotic infection rates of the 2 splenectomized groups were 13% and 33.33% respectively, both significantly higher than that of Group C (29.3%), however, both not significantly. Acute rejection rate did not occurred in the 2 splenectomized groups, and in 4 cases of the non-splenectomized group, however, without significant differences among them. The post-operative bleeding rate of Group B was significantly higher than that of Group C (P < 0.05). The accumulative survival of Group C was significantly higher than that of Group B (P = 0.0001). The platelet counts 14 and 20 days after operation of the 2 splenectomized groups were all significantly higher than those of the non-splenectomized group (all P < 0.05), and were higher than the normal levels in some cases. CONCLUSION: Splenectomy does not benefit the patients undergoing liver transplantation whenever it is performed before or simultaneously in the liver transplantation.

Adult↗
PubMed1991

Effect of splenectomy on cell mediated immunity in bilharzial patients with splenomegaly.

The effect of splenectomy on cell mediated immunity was studied in 15 male patients with mean age 28 years +/- 9 s.d. with bilharzial splenomegaly and oesophageal varices, for comparison, ten healthy control males with mean age 28 years +/- 4 s.d. were included. The cellular immune response was assessed before and one month after splenectomy. The assessment included the enumeration of T lymphocyte subsets in vitro using monoclonal antibodies and in vivo by intradermal skin test for delayed reaction using specific Schistosoma mansoni adult antigen and non specific purified protein derivatives (P.P.D.). The result showed that the possibility of the delayed skin reaction was higher after splenectomy, also there was an increase in the number of T helper cells and reduction in number of T suppressor cell but the number of pan T cell did not significantly change. This result indicates that the ratio of T helper/T suppressor ratio improved after splenectomy with a concomitant improvement of the immunological response of the patients.

Adult↗
PubMed1990

[Splenectomy in the treatment of severe forms of myasthenia gravis].

The authors describe the results of clinical and electromyography examinations of 20 patients with grave generalized myasthenia, carried out within the short-term (up to 2 weeks) and long-term period (up to 1 year) after splenectomy. In these patients, the preceding therapy (thymectomy, gamma-therapy of the thymic area, the treatment with prednisolone, azathioprine, plasmapheresis, etc) had not produced any beneficial effect. The efficacy of splenectomy was assessed according to the Keens classification (A-E). In the short-term period after splenectomy the C effect was recorded in 13 out of the 20 patients. Out of 9 patients examined in the long-term period, the B effect was revealed in 3 patients, the C effect persisted in 3 patients, and 3 patients manifested the return to the initial status, namely to the E effect. Therefore in the group of patients with grave generalized myasthenia, the efficacy of splenectomy amounted to 65%. In view of this fact the inclusion of the given treatment method into the multimodality treatment of myasthenic patients is regarded advisable.

Adult↗