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PubMedDate not supplied

Effect of splenectomy on the morphology of haemolymph splenic nodes in Wistar rats.

MATERIAL AND METHODS: In 12 Wistar rats the gross and microscopic structure of haemolymph splenic nodes was assessed after splenectomy and the obtained results were compared with those in the control group. RESULTS: It was found that splenectomy leads to generalised morphological changes of the mentioned nodes, including, among other, their blanching, enlargement, filling with a greater number of morphotic elements and decreased count of erythrocytes and products of their disintegration. The splenic nodes demonstrated no regressive changes, typical of uniorgan nodes. The remaining abdominal non-haemolymph nodes in the rats showed no compensatory changes on gross examination after splenectomy.

Animals↗
PubMed2001

Hand-assisted laparoscopic splenectomy for idiopathic thrombocytopenic purpura during pregnancy.

A successful case of a hand-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum for autoimmune thrombocytopenic purpura in a patient at 23 weeks' gestation is reported. Preoperative splenic arterial embolization was performed on the same day as the operation using painless contour embolic material and super-absorbent polymer microspheres. The abdominal wall retraction method first was applied to avoid the effects of pneumoperitoneum on systemic hemodynamic alterations. However, a sufficient surgical view could not be obtained, as the intra-abdominal organs were elevated because of the enlarged uterus. A surgical view with 4 to 6-mm Hg pneumoperitoneum was available for the hand-assisted splenectomy. The postoperative course was uneventful, and the patient vaginally delivered a healthy infant. A hand-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum after splenic arterial embolization would be feasible for patients with autoimmune thrombocytopenic purpura during a relatively advanced pregnancy.

Adult↗
PubMed2001

Post-splenectomy multiple pancreatic pseudocysts.

A patient was admitted for breathlessness associated with post-splenectomy multiple pseudocysts and succumbed after internal drainage of the pseudocyst. Although the occurrence of pseudocyst following splenectomy is uncommon, failure to identify and treat this condition at an early stage could result in fatal consequences. Imaging plays an important role in the diagnosis and management of pseudocyst occurring after splenectomy. The advent of interventional radiology has provided better treatment option for patients with solitary pancreatic pseudocysts with success rates similar to those with open surgery but with lower morbidity and mortality rates. However, its role in the management of multiple pseudocysts remains to be defined.

Fatal Outcome↗
PubMed2001

[Splenectomy for hematologic disease. Mini-invasive versus traditional technique].

BACKGROUND: This study aimed to compare the safety, efficacy and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with hematologic disorders. METHODS EXPERIMENTAL DESIGN: prospective study; SETTING: II Department of Surgery, Santa Maria Nuova Hospital, Reggio Emilia and III Department of Surgery, Santo Spirito Hospital Pescara; PATIENTS: 48 consecutive adult patients underwent splenectomy; 30 patients under-went LS and 18 OS. Perioperative characteristics, outcomes, complications and costs were comparatively analyzed. RESULTS: Mean age was 35.3 years in the LS group, and 40.8 in the OS group. Mean spleen size was 11.7 cm in the LS group and 15.2 cm in the OS group. Accessory spleens were found in 5 patients in the LS group and in 4 patients in the OS group; 4 conversions to laparotomy occurred in the LS group. A total of 4 complications occurred in 3 patients of the LS; 9 complications occurred in 5 patients of OS group. Mean surgical time was 141.5 minutes for LS and 89.7 minutes for OS (p<0.005). Mean postsurgical stay was 5.8 days in the LS group and 8.5 days in the OS group (p<0.005). Response rates were similar in both groups. CONCLUSIONS: LS is comparable to OS in terms of efficacy and safety and it is associated with a shorter hospital stay. LS should become the technique of choice for treatment of intractable benign hematologic disease.

Adult↗
PubMed2001

Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter?

Laparoscopic resection has become the standard means for removal of normal-sized spleens in many medical centers. The application of minimally invasive techniques in the setting of splenomegaly is less well defined and was previously considered a contraindication to the laparoscopic approach. The purpose of this prospective study of consecutive patients was to compare the outcomes of patients undergoing laparoscopic splenectomy for normal-sized spleens (150 g or less) versus those with clear evidence of splenomegaly (500 g or greater). One hundred forty-two patients met the inclusion criteria. The most common diagnosis in the normal-sized spleen group was idiopathic thrombocytopenia purpura (67 of 82, 82%). Malignant hematologic diseases (lymphoma and leukemia) were the most common diagnoses in the splenomegaly group (35 of 60, 58%). Mean operative times (127 vs 172 minutes) and estimated blood loss (123 vs 173 cm3) were lower for those patients with normal-sized spleens (P < 0.05). There were no statistical differences in conversion rates, lengths of stay, or complications between the two groups. We conclude that laparoscopic splenectomy is safe and effective in the setting of splenomegaly despite modest but statistically longer operative times and increased operative blood loss when compared with laparoscopic splenectomy for normal-sized spleens.

Adolescent↗
PubMedDate not supplied

[Blood coagulation changes in patients with post-splenectomy persistent thrombocytosis].

To clarify the possible role of persistent thrombocytosis after splenectomy as being a predisposing factor causing thromboembolism. Blood coagulation profiles were studied in 35 patients (20 M and 15 F, mean age 42 +/- 17.5) suffering from thrombocytosis (> 500,000/dl) who underwent splenectomy for non-malignant and non-traumatic diseases. Seventy healthy subjects acted as a control group. Tests were performed 6 months after the operation and for both groups (patients and controls) blood samples were collected for: platelets, fibrinogen, PT, APTT, AT III, plasminogen, F1 + 2, t-PA and DNA analysis for F V, F II and MTHFR. After one year all subjects were controlled for thrombocytosis, genomic abnormalities and venous thrombosis. All the analyses were performed according to the Statistical Package for Social Science. The significance of the differences in means was evaluated by non-parametric tests, differences with a P value < 0.05 being considered significant. Increased plasma levels of fibrinogen, D-dimer, F1 + 2 and PAI-1 were found in the patients compared with the control group. TPA was significantly lower in the patients than in the controls. At the one year follow-up, two patients with genetic polymorphism had suffered deep venous thrombosis. Our findings indicate that splenectomy contributes to abnormal platelet aggregation and endothelial cell activation with hypercoagulability.

Adult↗
PubMed1975

[Laparotomy with splenectomy in Hodgkin's disease. Critical study of results in 123 patients].

123 laparotomies with splenectomy have been performed in 3 groups of patients. 1. 40 patients with infra-diaphragmatic relapses afer mantle field radiotherapy for supra-diaphragmatic disease. 2. 45 previously untreated patients. 3. 37 stages III B patients treated by intensive chemotherapy before splenectomy. Anatomical findings suggest that hematogenous dissemination may be responsible for spleen involvement and that spleen involvement may be suppressed by chemotherapy. In view of these data, chemotherapy in association with radiotherapy seems to be justified even in patients with apparently localised forms since the spleen may be involved in such patients at clinical presentation of the disease. From the preliminary results of studies which aim to appreciate the effectiveness of chemotherapy on splenic lesions, the need for routine laparotomy and splenectomy should be reevaluated.

Drug Therapy, Combination↗
PubMed1975

Therapeutic splenectomy.

An eight-year experience at Charity Hosptial and Touro Infirmary indicates that 10 percent of splenectomies were performed for reasons other than trauma or malignancy. Fifty-nine per cent of therapeutic splenectomies were done for congenital spherocytosis or idiopathic thromboytopenic purpura. All patients having spherocytosis and 57 per cent having ITP had favorable response following splenctomy. Seven surgical death occurred following 69 splenectomies (mortality 10%). Three deaths were from pulmonary emboli, three from hemorrhagic disorders and one from peritonitis. Eighteen postopertive complications occurred, the most frequent being thromboembolic disease. Prophylactic anticoagulants were not used in any patient.

Anemia, Hemolytic↗
PubMedDate not supplied

Restoration of portal vein flow by splenorenal shunt ligation and splenectomy after living-related liver transplantation.

We describe here a case of living-related liver transplantation with a spontaneous splenorenal shunt. On the third postoperative day, Doppler ultrasound follow-up revealed impairment of intrahepatic portal vein flow and reoperation was performed. Intraoperatively, simple compression of the collateral veins forming the splenorenal shunt resulted in an immediate change in the portal flow pattern, which suggested the absence of a portal thrombus. Splenectomy and ligature of the more dilated collateral veins were carried out and satisfactory portal flow was restored. Although the role of splenectomy was controversial, splenectomy provided an increased portal vein flow in the present case. The uneventful postoperative course validated our decision.

Adult↗
PubMed2001

[Application of laparoscopic technique in splenectomy].

OBJECTIVE: To investigate the application and effect of laparoscopic splenectomy (LS) in the treatment of spleen diseases. METHODS: Under CO2 pneumoperitoneum, laparoscopic splenectomy was performed on 43 patients. General conditions before and after operation, platelet counting, complications and recovery of patients were studied. RESULTS: Laparoscopic splenectomy was performed without complications in all the patients. In the patients with ITP, the effective rate of LS was 89.3%. The difficulty of operation was identified when the diameter of the spleen was over 15 cm assessed by ultrasonic examination, and the operative time was usually prolonged. CONCLUSIONS: LS is one of the best choices when proper indications exist and good techniques under laparoscopy are provided.

Adolescent↗
PubMed2002

Laparoscopic splenectomy has become the gold standard in children.

Splenectomy is frequently required in children with various hematologic disorders. The reported advantages of laparoscopic splenectomy (LS) include less pain, shorter hospital stay, and improved cosmesis. This report evaluates the outcome of children undergoing LS at a single children's facility. One hundred twelve children underwent LS by the lateral approach between August 1995 and February 2001. Indications for LS were hereditary spherocytosis in 58, idiopathic thrombocytopenic purpura in 21, sickle cell disease in 19, and other conditions in 14. LS alone was completed in 89 children and LS and cholecystectomy (LSC) in 20. Three required conversion to open splenectomy. Accessory spleens were identified in 19. Complications included ileus (four), acute chest syndrome (four), bleeding (two), pneumonia (one), and diaphragm perforation (one). There was no mortality. An accessory spleen was missed in one child with recurrent anemia. Average operative time for LS was 106 minutes and for LSC 135 minutes. Operative time for LS decreased with experience but the difference was not significant. Average length of stay was 1.51 days (range 1-11) and was longer in sickle cell disease (2.47 days) versus hereditary spherocytosis (1.29 days) and idiopathic thrombocytopenic purpura (1.16 days). We conclude that LS is safe and effective in children with hematologic disorders and is associated with minimal morbidity, zero mortality, and a short length of stay.

Adolescent↗
PubMed2002

Splenectomy in sarcoidosis: indications, complications, and long-term follow-up.

BACKGROUND: Management of splenic enlargement due to sarcoidosis consists of primarily medical therapy with prednisone, methotrexate or antimalarial drugs. Splenectomy is the last resort because of the concern about complications of surgery. AIM: This study was conducted to explore indications for splenectomy in sarcoidosis and to assess if complications associated with splenic removal were unacceptable. METHODS/RESULTS: 13 sarcoidosis patients had their spleens removed for one or more of the following four reasons: (1) Massive splenomegaly; (2) Severe hypersplenism; (3) Need for excluding lymphoma or malignancy; and (4) Precaution against splenic rupture. All patients received strict prophylactic protocol and were followed over a period ranging from 1 to 30 years. CONCLUSION: In this long term follow-up study none of the thirteen patients developed serious infections or sepsis. No deaths occurred that might be related to splenectomy.

Adolescent↗
PubMedDate not supplied

[Laparoscopic splenectomy: analysis of 60 consecutive cases].

The purpose of the study was to analyze the results of 60 patients who were candidates for laparoscopic splenectomy. Over the period from May 1994 to May 2001, 60 patients were candidates for splenectomy. Laparoscopy was contraindicated in 3 cases because of ASA III and marked splenomegaly (2 cases) and previous gastric resection (1 case). The procedure was indicated for benign disease in 38 cases and for malignant disease in the remainder. Fifty-three procedures were completed laparoscopically (92.9%). Conversion proved necessary in 4 patients (6.7%) due to large incisional hernia, perisplenic abscess, bleeding of major splenic vessels at the hilum and marked splenomegaly (2 cases of lymphoma). The mean operative time was 200 min for the malignancies and 110 min for the benign conditions (P < 0.05). Major morbidity occurred in 5 cases (8.7%). No deaths were registered. The mean postoperative hospital stay was 7.5 days for patients with malignancies and 5.2 days for patients with benign disease (P < 0.05). Laparoscopic splenectomy was safe and effective in patients with benign disease, even in cases of marked splenomegaly. The morbidity rate was significantly higher in lymphoma patients than in patients with benign haematological disorders.

Adolescent↗
PubMed2002

[Technical aspects of laparoscopic splenectomy].

For the period of four years 22 patients were operated on for surgical disease of spleen, using laparoscopic technologies. Laparoscopic splenectomy was performed in 12 patients, manually assisted laparoscopic splenectomy using the Pneumo Sleeve (Dexterity firm) system and with application of the self made construction pneumosleeve--in 10. The operation duration was from 110 to 220 minutes. The hospital stay of the patient after the operation had constituted 2-4 days. The experience of laparoscopic splenectomy performance gained witnesses the possibility of successful application of the method for the treatment of surgical diseases of spleen.

Adolescent↗
PubMed2002

[Laparoscopic splenectomy in congenital hemolytic anemia in children].

Experience of 48 laparoscopic splenectomies in children aged from 3 to 14 years with congenital hemolytic anemia is analyzed. The main stages of laparoscopic splenectomy were the following: isolation of the inferior pole of the spleen, transection of the gastro-splenic ligament, transection of the splenic vascular trunk (with endostapler or intracorporeal ligature), dissection of the splenic ligaments, removal of the organ (with endoscopic sac or morcellator). One-stage cholecystectomy for cholelithiasis was performed in 11 patients. Time of surgery was 110-115 minutes, on the average. One-stage cholecystectomy prolonged surgery by 30-40 minutes. There were no intraoperative and postoperative complications. Conversion to open surgery was necessary in 2 cases because of endostapler failure. Patients were discharged on the 5-8th day after surgery. Physical activity restored completely 10-14 days after surgery. There were no lethal outcomes. Excellent cosmetic results were achieved in all the patients. Laparoscopic splenectomy in congenital hemolytic anemia is safe, sparing and effective endoscopic surgery in childhood.

Adolescent↗
PubMed1976

The coagulation and fibrinolytic response to splenectomy.

The responses of the coagulation and fibrinolytic systems in nine patients with Hodgkin's disease undergoing splenectomy and lymph node mapping have been compared with those in nine patients undergoing elective upper abdominal operation for benign conditions. Differences have been noted in base line levels of fibrinogen, prothrombin, partial thromboplastin time and euglobulin lysis time. Platelet count increases were exaggerated following splenectomy, but other parameters of coagulation activity behaved similarly in the two groups. There is no evidence from this study to support the suggestion that blood coagulability is increased more markedly following splenectomy than it is after other upper abdominal operations.

Abdomen↗
PubMedDate not supplied

Partial splenectomy for splenic cyst: a case report and literature review.

Splenic cysts are very rare. They were traditionally treated by splenectomy. The recognition of post-splenectomy complications has led to emphasis on conservative techniques. We present a thirteen year old girl with epithelial splenic cyst treated by partial splenectomy. The post-operative CT scan after two weeks confirmed the residual splenic tissue.

Adolescent↗
PubMedDate not supplied

Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.

A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. Gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. Splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.

Esophageal and Gastric Varices↗