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PubMed1985

Chromosome changes and splenectomy in Ph-positive CML. III. Predictive parameters in the chronic phase.

The findings presented indicate that splenectomy during the blastic phase (BP) of Philadelphia (Ph) positive chronic myeloid leukemia (CML) prolonged survival after the onset of the BP in a group of patients who had, in addition to the Ph, only chromosomally abnormal cells in the marrow (AA patients). To evaluate the predictive parameter for splenectomy in the chronic phase (CP) of CML, the cytogenetic data obtained during the CP of the AA group were compared retrospectively with those of cytogenetically defined groups. Only AA patients showed the presence of abnormal clone(s) containing abnormalities such as trisomy 8, i(17q), and a missing Y chromosome several years before the onset of BP. This may indicate that the presence of these chromosome abnormalities during the CP could be utilized as a predictive parameter for splenectomy in the CP of CML.

Actuarial Analysis↗
PubMed1992

Expression of heme oxygenase and its RNA in mouse liver after injection of heme and splenectomy.

Heme is known to activate the HO (heme oxygenase) gene in cultured cells, but little is known about the effect of heme on the HO gene in intact organisms. The expressions of HO and its RNA in mouse liver were measured using mouse HO cDNA and HO antibody after injection of heme or splenectomy. The antibody was prepared against a beta-galactosidase-HO hybrid protein made in Escherichia coli. The HO mRNA level increased to a maximum 15 h after heme injection. In contrast, expression of HO was maximal about 45 h after heme injection. Essentially the same results were obtained in mice after splenectomy. These results suggest that the HO gene in mouse liver was activated by the injection of heme and splenectomy.

Animals↗
PubMed2006

Evaluation of severe infection and survival after splenectomy.

PURPOSE: Splenectomized patients are known to be at risk of severe infection, but the extent of risk is unclear. We evaluated the incidence of severe infection and survival in 1648 splenectomized patients. METHODS: Patients who underwent splenectomy between 1988 and 1999 in Scotland were identified through the Scottish hospital discharge records (SMR01) and then linked to the death certificate data recorded by the General Register Office in Scotland to obtain clinical and demographical information. RESULTS: The overall rate of first severe infection was 7.0 per 100 person-years (95% confidence interval, 6.30-7.78). The overall rate for a second infection per 100 person-years was 44.9 and 109.3 for a third infection after the first episode of infection. Among the repeated episodes of severe infection, 42% to 76% and 61% to 84% of total episodes of second and third severe infection, respectively, occurred within 6 months after the first severe infection. The susceptibility to severe infection was greatest in older age groups (5.5 per 100 person-years in those aged > 50 years) and in patients splenectomized for hematologic malignancy (9.2), and iatrogenic splenectomy for malignancy disease (7.4). Between 50% and 80% of all severe infections or deaths occurred within 1 to 3 years after splenectomy. CONCLUSIONS: The risk of severe infection is an important health problem in splenectomized patients, especially in those who underwent surgery for malignancies. Antibiotic prophylaxis could offer the most benefits in the first 3 years postsplenectomy or the first 6 months after the occurrence of a first severe infection.

Adolescent↗
PubMedDate not supplied

Right portal vein thrombosis after splenectomy for trauma.

Portal vein thrombosis may complicate splenectomy in patients with hemolytic anemia and myeloproliferative disease, whereas the frequency of portal vein thrombosis in case of trauma is not defined. A case of right portal vein thrombosis after splenectomy for trauma is reported in this paper. Hematologic workup did not reveal an underlying platelet or coagulation disorder. The patient was promptly anti-coagulated with complete recanalization of the portal vein. We conclude that mild symptoms, like abdominal pain and fever, after splenectomy should be investigated with a color Doppler ultrasonography to confirm or rule out a diagnosis of portal thrombosis and to anti-coagulate the patient with thrombosis, thus preventing bowel infarction and secondary portal hypertension. Routine postoperative color Doppler might also be justified in all postsplenectomy patients (without hematologic diseases) for early detection of a portal vein thrombosis.

Abdominal Injuries↗
PubMed2006

[Chronic pulmonary thromboembolism revealing beta-thalassemia intermedia after splenectomy].

INTRODUCTION: The clinical expression of beta-thalassemia intermedia is variable and complications are more frequent than in the minor form. Thromboembolism risk increase after splenectomy. Few cases of the type of complications are reported. CASE RECORD: A man was admitted for beta-thalassemia intermedia with moderate chronic hemolysis anemia, complicated by chronic pulmonary thromboembolism and liver iron overload. Post-traumatic splenectomy probably increase the risk of this two complications. The patient's respiratory status improved following bosentan therapy without worsening his hepatopathy. CONCLUSION: The present study also notes that thromboembolism complications can be an indicator of beta thalassemia and interrogate about the risk and the benefit of splenectomy in the treatment of beta-thalassemia intermedia.

Antihypertensive Agents↗
PubMed2001

The learning curve associated with pediatric laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy (LS) is technically difficult compared with open splenectomy. This report examines our experience with LS to define the learning curve. METHODS: The first 49 consecutive laparoscopic splenectomies were reviewed. Indications, complications, operative time, and costs were recorded. RESULTS: Indications included hereditary spherocytosis, immune thrombocytopenia purpura, beta-thalassemia, lymphoma, splenic cysts, and abscesses. Surgical time averaged 196 minutes for the first 10 patients, decreasing to 105 minutes for the last 10. Blood loss for the first 10 patients averaged 50 cc and less than 5 cc for the last 10. There were 3 complications and 1 conversion to open operation. Operative and hospital charges averaged $6,670 and $13,402, respectively, for the first 10 cases compared with $5,278 and $10,863 for the last 10. CONCLUSIONS: LS can be performed safely with few complications. LS has a steep learning curve in the first 20 patients after which operative times decrease along with overall costs.

Child↗
PubMed2002

Laparoscopic splenectomy for massive splenomegaly.

BACKGROUND: Laparoscopic splenectomy (LS) is the preferred operative approach for diseases involving normal-sized spleens. Our experience with laparoscopic splenectomy in the setting of massive splenomegaly is presented. METHODS: A prospective review of patients undergoing LS for massive splenomegaly was conducted. Massive splenomegaly (MS) in adults was defined as a craniocaudal length >or=17 cm or a morcellated weight >or=600 g. In children, spleens measuring fourfold larger than normal for age were considered massive. RESULTS: Forty-nine patients with MS were treated with LS. The most common primary diagnoses were lymphoma and leukemia. Mean splenic length was 20 cm (15 to 27 cm), with weights ranging from 600 to 4,750 g. Twelve patients with supermassive splenomegaly (length >22 cm) required a hand-assisted laparoscopic approach. There were no conversions to open surgery. Mean operating time was 171 minutes (90 to 369). Mean blood loss was 114 cc (<30 to 600 cc). Average length of stay was 2.3 days (1 to 16). Minor postoperative complications occurred in 3 patients. CONCLUSIONS: Laparoscopic splenectomy in the setting of splenomegaly is safe and appears to minimize perioperative morbidity. In patients with supermassive splenomegaly, a hand-assisted laparoscopic approach may be required.

Adult↗
PubMed2003

How we do a bloodless partial splenectomy.

Partial splenectomy and Tru-cut biopsy are not routinely practiced because of the lack of vascular control to arrest bleeding. Using radiofrequency energy to coagulate the resection margin and biopsy tract, a 74-year-old woman with a tumor in the lower pole of the spleen underwent partial splenectomy and Tru-Cut biopsy of the spleen. Hemostasis was excellent. Blood loss was minimal and the patient was discharged with a functioning spleen. This new technique may allow safe and bloodless partial splenic resection and Tru-cut biopsy of the spleen, which might reduce the number of splenectomies performed and the consequent difficulties for the patient that can arise.

Aged↗
PubMed1985

Influence of gastric banding on stomach blood supply with or without concurrent splenectomy.

A lethal gastric perforation occurred after a gastric banding procedure, which was complicated with splenectomy. Prompted by this incident, an experimental study was undertaken in which regional blood flow in the stomach was measured in anesthetized cats after gastric banding or splenectomy or both. A fatal course with an extensive ischemic lesion of the stomach near the banding area was seen in all the cats with the combined procedure after 5 to 12 days. Banding alone reduced gastric blood flow within 24 hours, particularly on the greater curvature. Splenectomy also reduced blood flow along the greater curvature within 2 weeks. The combined procedure showed similar flow changes within 24 hours. The implication of these experimental results is that, if the spleen must be removed, the performance of gastric partitioning for morbid obesity should be reconsidered.

Adult↗
PubMed1996

Causes of death among patients surviving at least one year following splenectomy.

BACKGROUND: To assess the mortality (mostly long-term sequelae) of patients undergoing splenectomy, we carried out a population-based study in Sweden. METHODS: Using the unique personal identification number assigned to each Swedish resident, we linked centralized hospitalization records with nationwide mortality data. After initially assessing risks within the first 12 months after splenectomy, we excluded deaths during the first year and computed standardized mortality ratios (SMRs) for 1,297 patients splenectomized for external trauma and 991 surgically treated for nonmalignant conditions of adjacent organs who were alive at 12 months following surgery. The general Swedish population was used as the comparison. RESULTS: Both men and women undergoing splenectomy for external trauma had a 1.6-fold (SMR = 1.6) significantly elevated mortality risk, due mainly to circulatory diseases (particularly thromboembolism), alcoholism, digestive disorders, and external causes. Men also had a 28-fold increased mortality from septicemia and an excess of liver cirrhosis (mostly alcohol-related). Patients of both genders splenectomized for nonmalignant conditions had small but significantly elevated mortality overall (SMR = 1.4 to 1.5) reflecting excess risks for malignancies, diseases of blood-forming organs, external causes, and circulatory, respiratory, and digestive disorders. In addition, men had increased mortality from thromboembolism and pneumonia while women experienced elevated risks from septicemia. CONCLUSION: The excess mortality resulted from functional postsplenectomy defects (including sepsis and thromboembolism), behaviors increasing risk of traumatic splenic injury (eg, alcoholism), damage to other organs from the external trauma (eg, traumatic injury to the central nervous system/spinal cord), or the same or recurrent nonmalignant conditions for which surgery was performed (eg, gastric and duodenal ulcers).

Adolescent↗
PubMed1998

Is splenectomy more dangerous for massive spleens?

BACKGROUND: Reports vary about whether risks are greater for removal of massive (> or = 1500 g) spleens than for smaller (< 1500 g) spleens. We sought to determine the hazards of splenectomy. METHODS: We reviewed 223 consecutive adults with elective splenectomies for hematologic diseases. Morbidity and mortality rates were combined with published data to create a meta-analysis. RESULTS: Patients with massive spleens are more likely to have postoperative complications (relative risk [RR] 2.1, 95% confidence interval [CI] 1.3 to 3.4; P = 0.003) and death (RR 4.7, 95% CI, 1.5 to 15.1; P = 0.01). However, when the investigation is restricted to comparable diagnoses, patients with massive spleens do not differ from those with smaller spleens regarding complications (RR 1.4, 95% CI, 0.8 to 2.7; P = 0.3) or mortality (RR 2.1, 95% CI, 0.5 to 9.7; P = 0.4). These observations are confirmed by metaanalysis. Furthermore, multivariate analysis indicts age as a critical risk of complications and death. CONCLUSIONS: Increased age and underlying illness are the predominant factors associated with morbidity and mortality following splenectomy for hematologic disease. Adjusting for age and diagnosis, spleen size is not a hazard.

Age Factors↗
PubMed1998

Laparoscopic versus open splenectomy for immune thrombocytopenic purpura.

BACKGROUND: Laparoscopic splenectomy (LS) has been proposed as a substitute to open splenectomy (OS) in the treatment of immune thrombocytopenic purpura (ITP). The aim of this study was to compare two cohorts of patients with ITP who underwent OS or LS. PATIENTS AND METHODS: From February 1990 to January 1997, 27 patients underwent OS and 22 LS. Perioperative characteristics, outcomes, and complications were comparatively analyzed. RESULTS: Mean age was 38 years (+/- 16) in the OS group, and 39 (+/- 16) in the LS group; the male: female ratio was 1:2 in both groups. Median preoperative platelet count was 16 x 10(9)/L (range 2 to 186 x 10(9)/L) in the OS group, and 50 x 10(9)/L (2 to 241 x 10(9)/L) in the LS group. Mean operative time was 2.7 hours (+/- 0.7) for OS, and 4.5 hours (+/- 1) for LS (P <0.0001). Two conversions to laparotomy occurred in the LS group. A total of 14 complications occurred in 10 patients of the OS group; 8 complications occurred in 6 patients of the LS group. Two patients died in the OS group and 1 in the LS group. Mean postoperative discharge was 6 days (3 to 44) in the OS group and 4 days (2 to 11) in the LS group (P <0.02). Response rates were similar in both groups. CONCLUSIONS: Laparoscopic splenectomy is comparable to OS in terms of efficacy and safety, and it is associated with a shorter hospital stay.

Adult↗
PubMed1999

Splenectomy in high-risk patients with splenomegaly.

BACKGROUND: Splenectomy in patients with massive splenomegaly and hematologic malignancy results in higher morbidity and mortality with primarily palliative benefit. METHODS: From a 14-year experience with 172 splenectomies, the perioperative course of 39 high-risk patients with splenomegaly was reviewed for comorbidities, indications, complications, and mortality. RESULTS: Twenty-three males and 16 females with a mean age of 54.2 years and a mean 12.8-day postoperative length of stay were reviewed. Sixteen patients (41%) had 23 major complications related to age (P = 0.047) and operative time (P = 0.01). Intraoperative transfusion was related to splenic size (P = 0.04), and estimated blood loss (P = 0.02) was inversely related to use of splenic artery preligation. Three perioperative deaths were secondary to sepsis and multi-organ system failure. CONCLUSION: Splenomegaly and comorbidities of the primary disease result in higher morbidity and mortality. Splenic artery preligation is valuable to limit intraoperative blood loss and facilitate splenectomy.

Comorbidity↗
PubMed2000

[Median and long-term complications of splenectomy].

Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, especially septic and thromboembolic complications occurring after splenectomy, have been reported. The septic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate, about 50%. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients. The thromboembolic complications are rare, little studied, and specific preventive procedures have not been implemented.

Adult↗
PubMed2003

[Preoperative selective embolization allowing a partial splenectomy for splenic hamartoma].

PURPOSE OF THE STUDY: To underline value of the preoperative splenic embolization with haemostatic aim to facilitate partial splenectomy. MATERIAL: Observation of a 23-year-old woman, admitted for pain, anemia, and mass of the left hypochondrium. Sonography, helical CT and MRI showed that the bulky mass was developed from the upper pole of spleen, and dislodged the left kidney towards the pelvis. This mass had fibrous characteristics in favour of a primary lesion with recent bleeding and was compatible with a splenic hamartoma. METHODS: Selective partial splenic embolization with haemostatic aim using metal coils, immediately followed by surgery. RESULTS: Preoperative embolisation made possible to carry out under optimal surgical conditions a partial splenectomy with en-bloc resection of the splenic mass. Histologic diagnosis was splenic hamartoma of pulpar type. CONCLUSION: This case illustrates the interest of accurate characterization of splenic lesions by several imaging techniques allowing indication for conservative surgery, and of preoperative embolization facilitating a partial splenectomy.

Adult↗
PubMed1983

Overwhelming post-splenectomy infection in Hodgkin's disease: pathogenesis and prevention.

After staging splenectomy, the risk of overwhelming sepsis in patients with Hodgkin's disease reaches 21% in certain subgroups. Youth, recent splenectomy and vigorous chemoradiotherapy predispose patients to this complication. Because of its explosive course and its known microbiology, post-splenectomy sepsis is better suited to prevention than to treatment. Since immunisation prior to treatment produces good antibody responses, all patients with Hodgkin's disease should probably be vaccinated against encapsulated bacteria at least 10 days prior to the onset of therapy.

Adolescent↗
PubMed2003

Splenectomy attenuates intestinal ischemia-reperfusion-induced acute lung injury.

BACKGROUND/PURPOSE: Intestinal ischemia-reperfusion (IIR) induced acute lung injury (ALI) has been documented. Kupffer cell blockage with gadolinium chloride (GdCl(3)) has been shown to attenuate IIR-induced ALI. However, the effects of splenic monocytes/macrophages on IIR-induced ALI has not been studied previously. In the current study, the authors aimed to investigate the role of splenectomy in IIR-induced ALI. METHODS: Forty-eight rats were divided randomly into 6 groups as follows: SHAM, SHAM + KCB, SHAM + SPLN, IIR, IIR + KCB, IIR + SPLN. Two hours of ischemia and 1 hour of reperfusion has been applied by clipping the SMA. GdCl3 was given 24 hours before experiment. Splenectomy was done just before SMA clipping. Lung levels of tumor necrosis-factor (TNF), interleukin (IL)-6, myeloperoxidase (MPO), and malondialdehyde (MDA) were assayed biochemically. Lung leukosequestration was determined by counting PMNLs histologically. Kruskal-Wallis and Mann-Whitney U tests were done; P values less than.003 were considered significant. RESULTS: Polimorphonuclear leukocyte (PMNL) counts and biochemical parameters in the IIR group were significantly higher than the other groups (P <.003). When compared with IIR group, PMNL counts and biochemical parameters were significantly decreased in the IIR+KCB and IIR+SPLN groups, respectively (P <.003). However, they were still significantly higher than their sham-operated controls (P <.003). CONCLUSIONS: This study documents that splenectomy attenuates ALI as well as Kupffer cell blockage. Spleen, an important component of mononuclear phagocytic system as liver Kupffer cells, might play an important role in the IIR-induced ALI.

Animals↗
PubMed1978

Partial splenectomy in staging laparotomy for Hodgkin's disease: an alternative approach.

Partial splenectomy, with resection of the lower one-fourth to one-third spleen, was performed in 10 children with Hodgkin's disease as part of an otherwise standard staging laparotomy. The technique proved to be safe and practical, with no postoperative complications. No evidence to date indicates that splenic involvement was missed, and all the children have thus far continued to do well, with no deaths from either underlying disease or postsplenectomy sepsis. The procedure is undergoing a prospective clinical trial in an effort to determine whether or not it is comparable from a diagnostic point of view to total splenectomy. Available data indicate that the risk of missing intraabdominal disease in a staging laparotomy with a partial splenectomy is quite low. Such a procedure should eliminate the substantial risk of postsplenectomy sepsis in such children.

Adolescent↗