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PubMed1998

Splenic artery embolization before laparoscopic splenectomy. An update.

BACKGROUND: This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. METHODS: Preoperative splenic artery embolization was used in 26 of 54 patients (48%) undergoing laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm (group I), except the first two (18/20). An anterior surgical approach was used. After 1994 (group II), embolization was not used for these patients (0/26), and a lateral surgical approach was used. Throughout the study period, all patients with spleens longer than 20 cm had embolization (8/8). RESULTS: Five complications occurred, three related to the use of small-particle embolic material (microspheres, gelatin foam powder). In group I, the conversion rate was lower than that of most current series, largely because of embolization. In group II, similar results were obtained because of experience and a better surgical approach (i.e., lateral). CONCLUSIONS: Preoperative splenic artery embolization is not necessary for spleens shorter than 20 cm. Increased experience and mostly the lateral surgical approach have permitted a shorter operation and a low conversion rate (4%) similar to the rate achieved with embolization and the anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolization, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).

Angiography↗
PubMed1999

Effect of spleen size on splenectomy outcome. A comparison of open and laparoscopic surgery.

BACKGROUND: Laparoscopic splenectomy (LS) is gaining acceptance as an alternative to open splenectomy (OS). However, splenomegaly presents an obstacle to LS, and massive splenomegaly has been considered a contraindication. Analyses comparing the procedure with the open approach are lacking. The purpose of this study was to analyze the effect of spleen size on operative and immediate clinical outcome in a series of 105 LS compared with a series of 81 cases surgically treated by an open approach. METHODS: Between January 1990 and November 1998, 186 patients underwent a splenectomy for a wide range of splenic disorders. Of these patients, 105 were treated by laparoscopy (group I, LS; data prospectively recorded) and 81 were treated by an open approach (group II, OS analyzed retrospectively). Patients also were classified into three groups according to spleen weight: group A, <400 g; group B, 400-1000 g; and group C, >1000 g. Age, gender, operative time, perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia, length of stay, and morbidity were recorded in both main groups. RESULTS: Operative time was significantly longer for LS than for OS. However, LS morbidity, mortality, and postoperative stay were all lower at similar spleen weights. Spleens weighing more than 3,200 g required conversion to open surgery in all cases. When LS outcome for hematologic malignant diagnosis was compared with LS outcome for a benign diagnosis, malignancy did not increase conversion rate, morbidity, and transfusion, even though malignant spleens were larger and accessory incisions were required more frequently. Postoperative hospital stay was significantly longer in malignant than in benign diagnosis (5 +/- 2.4 days vs. 4 +/- 2.3 days; p < 0. 05). CONCLUSIONS: In patients with enlarged spleens, LS is feasible and followed by lower morbidity, transfusion rate, and shorter hospital stay than when the open approach is used. For the treatment of this subset of patients, who usually present with more severe hematologic diseases related to greater morbidity, LS presents potential advantages.

Adult↗
PubMed2004

Accessory splenectomy with gastroesophageal devascularization for recurrent hypersplenism and refractory bleeding varices in a patient with liver cirrhosis: report of a case.

We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 x 6 x 5 cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent 99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.

Adult↗
PubMed1983

Massive omental reticuloendothelial cell lipid uptake in Tangier disease after splenectomy.

Tangier disease is a rare, autosomal recessive condition characterized by cholesterol ester deposition in reticuloendothelial cells, abnormal chylomicron remnants, decreased low-density lipoprotein levels, and a marked deficiency of high-density lipoproteins. Apolipoprotein A-I, a major protein constituent of chylomicrons and high-density lipoproteins, has been shown to be structurally and metabolically abnormal in this disease (apolipoprotein A-ITangier). A 63-year-old Tangier homozygous man is described, who underwent splenectomy because of thrombocytopenia and splenomegaly. Subsequently, a large orange mass developed at the base of the mesentery, with several smaller omental masses and thickening of the entire omentum due to infiltration with lipid-laden macrophages. Splenectomy appears to predispose to such deposition, since such masses have not been observed in other Tangier homozygotes. The spleen appears to play a significant role in the removal of abnormal lipoproteins in Tangier homozygotes; therefore, splenectomy may be contraindicated in Tangier disease.

Apolipoproteins↗
PubMed1975

Role of splenectomy in Felty's syndrome.

To evaluate the effectiveness of splenectomy in the treatment of Felty's syndrome (association of rheumatoid arthritis, leukopenia, and splenomegaly), such experience from 1968 to 1972 at the University of Alabama Medical Center in Birmingham was analyzed. There were five patients with Felty's syndrome who underwent splenectomy. In all five patients, there was no operative morbidity, no blood transfusions were required, and leukopenia and susceptibility to infection were greatly improved; neutropenia disappeared in all but one patient. Splenectomy appears to benefit most patients with Felty's syndrome.

Aged↗
PubMed1979

Incidental splenectomy: early and late postoperative complications.

Of 542 splenectomies performed from 1964 to 1977, 242 were incidental to gastrointestinal surgery. The highest rate of complications was observed in these patients as opposed to those who underwent splenectomy for trauma or Hodgkin's disease. Eighteen laboratory studies did not show significant changes 1.5 to 10 years postoperatively in 96 patients. Ninety-three patients questioned because of late symptoms had the highest rate of complaints after incidental splenectomy.

Blood Cell Count↗
PubMed1982

Outcome and sepsis after splenectomy in adults.

Of 277 splenectomies performed over 10 years, 24.2 percent were incidental. Operative mortality in this group was 14.9 percent, which is higher than that encountered after splenectomy for any other indication. A majority of the deaths were from septic causes, and infectious complications accounted for most of the morbidity as well. This finding is in marked contrast to the paucity of infectious morbidity and mortality in patients with all other splenectomies. Of the 251 patients who survived these operations, follow-up was available on 175. Twenty-six had received Pneumovax, and 4 of these patients died, none from infectious causes. There were 20 septic deaths among the 149 unvaccinated patients, including 3 cases of fulminant pneumococcal sepsis.

Bacterial Infections↗
PubMed1984

The negative effect of splenectomy on the prognosis of gastric cancer.

During the 11 year period from 1970 through 1980, 103 patients underwent total gastrectomy for gastric cancer. Splenectomy was performed in 53 of the patients because of perioperative accidental injury or an operative finding of tumor metastasis to the lymph nodes or direct invasion to the splenic hilus. Retrospective comparisons were carried out among the 53 splenectomized and 50 nonsplenectomized patients in terms of the long-term survival rate and early and late complications. The two groups of patients were quite similar with regard to rates of curative resection and stages of disease. The 5 year cumulative survival rates overall and in the splenectomized and nonsplenectomized groups were 23.1, 21.8 and 23.8 percent, respectively. Splenectomy did not affect the prognosis of gastric cancer. In addition, there were no differences between the two groups in the incidences of early surgical complications and infectious disease of late onset. Our results suggest that, in the treatment of gastric cancer, splenectomy may not be avoided, either when the spleen is injured perioperatively or when cancer involvement is suspected in the splenic hilus.

Combined Modality Therapy↗
PubMed1975

Intra-erythrocytary enzymes before and after splenectomy.

The activity of the intraerythrocytary enzymes glucose-6-phosphate dehydrogenase, pyruvate kinase, glutathione reductase and ATPase was measured before and after splenectomy in 13 patients with congenital hemolytic anemia and 3 patients suffering from chronic thrombocytopenia. All patients were treated successfully, as reflected by clinical and basal hematological parameters. Glucose-6-phosphate dehydrogenase and pyruvate kinase were significantly depressed after splenectomy. It was not possible to set up prognostic criteria of splenectomy from the intraerythrocytary enzymes.

Adenosine Triphosphatases↗
PubMed1991

Influence of splenectomy on the properties of erythrocytes with hemoglobin Volga disease.

Hemoglobin Volga is a rare unstable hemoglobin in which there is a replacement of an internal alanine residue, beta 27 (B9), by an aspartate. From a clinical point of view it is characterized by a moderately severe Heinz body hemolytic anemia. A possible clue to the cause of the hemolysis is the increased vulnerability to oxidation of Hb Volga, with increased free radical turnover and consequent damage to the red cell membrane. Splenectomy performed on carriers of Hb Volga may have a positive outcome leading to improvements in both the clinical condition of the patient and hematological variables such as hemoglobin concentration and bilirubin concentration. With the aim of defining a more complete biochemical picture of the beneficial effect of splenectomy in this disease, we have evaluated some enzymic activities of the red cells of a young patient with Hb Volga disease, before and after splenectomy. In particular, we have investigated the activity of superoxide dismutase (superoxide: superoxide oxidoreductase), glutathione peroxidase (GSH peroxidase, glutathione: hydrogen-peroxidase oxidoreductase) and catalase (hydrogen-peroxide: hydrogen-peroxide oxidoreductase) that catalyze reactions relevant to the steady-state concentration of potentially toxic oxygen derivatives such as O2- and H2O2. Besides, we have carried out experiments on the erythrocytic membrane to evaluate eventual changes on the chemical (i.e. peroxidation) and physico-chemical (i.e. fluidity) properties following surgery.

Anemia, Hemolytic↗
PubMed1995

Vertical partial splenectomy for epidermoid cyst.

Benign lesions of the spleen usually can be surgically removed by partial splenectomy. When the lesion is longitudinal and occupies most or the entire length of the spleen, partial splenectomy using the common surgical technique, based on the distribution of the organ's blood supply, is impossible. A new approach for "vertical" partial splenectomy for epidermoid cyst is described, using splenic artery occlusion and straight suture needles.

Child↗
PubMed1984

The effect of tuftsin and splenectomy on mortality after intraabdominal sepsis.

A murine model of cecal ligation and puncture (CLP) was used to test the effect of tuftsin, with or without splenectomy, on mortality following intraabdominal sepsis. There were no deaths among shamoperated control mice after ether anesthesia, whereas CLP produced an 100% mortality by 24 hr. When CLP was followed at 16 hr by excision of the cecum and saline peritoneal lavage, the mortality rate was 20% at 24 hr and 60% at 72 hr. When tuftsin (1 mg/kg) was given only at 0, 12, and 24 hr in the CLPE model, the mortality rates were not significantly lower than CLPE alone (10% at 24 hr, 40% at 72 hr). When the tuftsin dose was increased to every 12 hr for 3 days, the mortality fell significantly to 0 and 13.5% at 24 and 72 hr (P less than 0.05 chi 2 vs CLPE ). Splenectomy 2 weeks prior to CLPE did not alter mortality (11% at 24 hr, 53% at 72 hr). When tuftsin was administered to the splenectomized animals undergoing CLPE , mortality did not change significantly (13.5% at 24 hr, 38% at 72 hr). These data suggest that tuftsin can confer protection from sepsis in animals with normal spleens, but it must be given longitudinally to be effective optimally. Splenectomy followed 2 weeks later by CLPE did not lead to increased mortality, and tuftsin did not reduce mortality in the asplenic animal.

Abdomen↗
PubMed1985

Response to immunization after partial and total splenectomy.

Survival after infection from Streptococcus pneumoniae in both animals and man is influenced by the amount of splenic tissue. We investigated the effect of differences in splenic weight upon the antibody response to immunization and the effect of immunization upon survival after pneumococcal challenge. Young Sprague-Dawley rats had either sham operation, hemisplenectomy, splenectomy with splenic autotransplantation, or total splenectomy. Nine weeks later, rats were immunized with a heat- and formalin-killed type-specific pneumococcal vaccine. Antibody response measured by radioimmunoassay was similar in all operative groups and was significantly higher than in nonimmune rats (P less than 0.01). Splenic weight was less after hemisplenectomy or autotransplantation than in sham-operated animals (P less than 0.01). Immunization improved survival after live pneumococcal challenge in rats that had autotransplantation and total splenectomy (P less than 0.001). Our results demonstrate that splenic weight does not affect the antibody response to pneumococcal immunization in rats. Immunization improves survival after bacterial challenge in susceptible animals and minimizes the detrimental effect of reduction in splenic mass.

Animals↗
PubMed1986

The effects of heparin and splenectomy on survival and plasma fibronectin levels in rat peritonitis.

Splenectomized patients are predisposed toward developing overwhelming bacterial infections. Administration of heparin is known to improve the survival of animals with intraabdominal sepsis and endotoxemia. The present study evaluates the effect of splenectomy and heparin administration on survival and plasma fibronectin (FN) levels in rats during acute bacterial peritonitis. Peritonitis was induced by cecal ligation and puncture (CLP) in 48 male Sprague-Dawley rats divided into four equal groups (12 each). Eight rats (66.7%) survived 10 days following CLP. When splenectomy was performed simultaneously (CLPS), the survival rate declined to 16.7% (P less than 0.05). Twenty units of heparin given subcutaneously daily for 5 days improved the survival rate to 66.7% following CLPS (P less than 0.05). When heparin was administered following CLP, the survival rate improved to 83.3% (not significantly higher than CLP alone). Plasma FN levels were measured by enzyme-linked immunosorbent assay (ELISA) on Days 0, 1, 2, 4, 7, and 10 following surgery. The plasma FN levels in splenectomized rats (CLPS +/- heparin) and nonsplenectomized rats (CLP +/- heparin) peaked on the first and second postoperative days, respectively. In comparing FN levels, no significant differences were found between the groups except on the second day--the CLPS + heparin group had a significantly lower FN level on Day 2 than CLP +/- heparin. This suggests that heparin confers protection from intraabdominal sepsis not only in animals with normal spleens but also in splenectomized animals. Plasma FN levels are not strongly influenced by heparin administration and concomitant splenectomy.

Animals↗
PubMed1989

Pneumococcal vaccine improves pulmonary clearance of live pneumococci after splenectomy.

The efficacy of pneumococcal capsular polysaccharide vaccines after splenectomy to decrease the incidence of postsplenectomy pneumococcal sepsis is controversial. We examined the effect of pneumococcal vaccine on clearance of live pneumococci from lungs of splenectomized and sham-operated mice following an aerosol challenge of pneumococci. Splenectomy impaired clearance of pneumococci from mouse lungs and allowed for increased translocation of pneumococci to tracheobronchial lymph nodes compared to shams (P less than 0.01). Pneumococcal vaccine improved lung clearance in both splenectomized and sham-operated mice compared to saline controls (P less than 0.01), but the number of live pneumococci recovered from lung pairs was greater in splenectomized mice compared to shams (P less than 0.01). Pneumococcal vaccination facilitated earlier translocation of pneumococci to tracheobronchial lymph nodes, and probably promoted bactericidal activity in these nodes, in both splenectomized and sham-operated mice. Survival in splenectomized mice was improved by vaccination, but remained significantly less than that in saline-treated sham-operated mice (P less than 0.0009). The data show that pneumococcal vaccine can improve lung antipneumococcal defenses in splenectomized mice, but not to the same degree as in mice retaining their spleens. Pneumococcal vaccine should be given after splenectomy, but surgeons should caution patients that it may be less effective than when given to individuals with intact spleens or before elective surgery.

Animals↗
PubMed1992

Effects of splenectomy and splenic artery ligation on the portal pressure in portal hypertensive rats.

Immediate, short-, and long-term effects of splenectomy and splenic artery ligation on the portal pressure were studied in animal models experimentally created by partial portal vein ligation. The portal pressure of these animals would usually elevate immediately after partial ligation of the portal vein from a normal level of 6.0 +/- 0.5 to 14.8 +/- 1.3 mm Hg (P < 0.005), which could be maintained at least for 6 months. The portal pressure measured at 2 weeks, 4 weeks, and 6 months after portal vein ligation was 14.0 +/- 2.7, 15.2 +/- 2.7, and 12.7 +/- 2.0 mm Hg, respectively (P < 0.005, as compared with the normal). When splenectomy was performed on these animals at 2 weeks after partial portal vein ligation, the pressure dropped immediately but only transiently from 14.0 +/- 2.7 to 11.0 +/- 3.0 mm Hg, and bounced back to the presplenectomy level in 20 sec. After an additional 2 weeks, the portal pressure in these splenectomized rats was usually at 15.2 +/- 4.2 mm Hg, which was indistinguishable from that of rats whose portal vein was ligated but the spleen was not removed. Six months after splenectomy, however, the portal hypertensive rats had a portal pressure of 17.1 +/- 6.4 mm Hg, which was significantly higher than that of the controls. Splenic artery ligation, on the other hand, did not result in any immediate decrease in portal pressure (14.0 +/- 2.7 mm Hg vs 14.6 +/- 1.4 mm Hg; P > 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

The rare indication for splenectomy as part of cytoreductive surgery in ovarian cancer.

Advanced ovarian carcinoma is being treated with aggressive debulking surgery including complete removal of the tumor whenever possible followed by adjuvant therapy. Secondary debulking including splenectomy in a patient with recurrent ovarian carcinoma is reported. It is suggested that splenectomy may have a place in the management of a few patients with ovarian cancer. The technique and complications of splenectomy are described.

Aged↗
PubMed1984

Chromosome changes and splenectomy in Ph1-positive CML. II. Prognostic aspects in the blastic phase.

The effect of splenectomy during the blastic phase (BP) in Philadelphia (Ph1) positive chronic myeloid leukemia (CML) was correlated with the chromosome findings during that phase of the disease. Fifty-three patients were divided into six groups on the basis of the chromosome findings and splenectomy; i.e., nonsplenectomized and splenectomized patients with only a Ph1 clone (PP/S- and PP/S+); nonsplenectomized and splenectomized patients with a clone containing only a Ph1 and another clone with karyotypic changes in addition to the Ph1 (AP/S- and AP/S+), and nonsplenectomized and splenectomized patients with only abnormal clone(s) containing karyotypic abnormalities in addition to the Ph1 (AA/S- and AA/S+). The percentage of patients with a good therapeutic response in each group was higher in splenectomized than nonsplenectomized patients. The median survival after the onset of BP was 171 days (5.7 months) in PP/S-, 167 days (5.6 months) in PP/S+, 136 days (4.5 months) in AP/S-, 183 days (6.1 months) in AP/S+, 23 days (0.8 months) in AA/S-, and 155 (5.2 months) in AA/S+. Statistically, there was a significant difference only between AA/S- and the other groups. These findings may indicate that splenectomy during the blastic phase could contribute to an improved tolerance to chemotherapy in each group and prolong the survival after the onset of BP in AA patients.

Adolescent↗