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PubMedDate not supplied

Laparoscopic splenectomy in the management of benign and malignant hematologic diseases.

OBJECTIVES: The use of laparoscopy to treat malignant hematological diseases is not completely accepted. Our aim was to analyze operative and postoperative results of laparoscopic splenectomy performed for benign versus malignant hematological disorders. METHODS: Between 1994 and 2003, 76 consecutive patients underwent laparoscopic splenectomy. The first 38 cases were performed by using an anterior approach, whereas in the remaining 38 cases a semilateral position was used. RESULTS: Baseline characteristics showed that patients with malignant diseases were significantly older (56.9 vs 32.6 years, P < 0.001). Seventy-two (94.7%) procedures were completed laparoscopically. Conversion was required in 4 cases (5.2%). Mean operative time was 138.5 minutes for benign and 151.0 minutes for malignant diseases, (P > 0.05, ns). The hand-assisted technique was used in 3 patients with massive splenomegaly. Pathologic features showed that spleen volume was higher in patients with malignant diseases (mean interpole diameter 18.1 cm vs 13.7 cm, P < 0.001). Massive splenomegaly (interpole diameter over 20 cm, weight over 1000 g) was present in 13 patients (17.1%); 9 had malignant diseases. Overall perioperative mortality was 1.3% and major postoperative complications occurred in 6 patients (7.8%). Postoperative splenoportal partial thrombosis was identified in 9.7% of patients. CONCLUSIONS: Laparoscopic splenectomy is a well-accepted, less-invasive procedure for hematological disorders. Neoplastic diseases or splenomegaly, or both, do not seem to limit the indications for a minimally invasive approach after the learning curve.

Adolescent↗
PubMed2006

Clinical inquiries. Which vaccinations are indicated after splenectomy?

Immunization against encapsulated bacterial pathogens decreases the incidence of post-splenectomy sepsis. Pneumococcal, meningococcal, and Haemophilus influenzae (Hib) vaccinations are indicated for patients after splenectomy. These immunizations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day (strength of recommendation [SOR]: A, based on systematic review of RCTs for the pneumococcal vaccine; SOR: B, based on systematic review of clinical trials for meningococcal and Hib vaccines).

Bacterial Infections↗
PubMedDate not supplied

The Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) A retrospective review of 379 patients undergoing laparoscopic splenectomy.

In December 2000, the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was formally launched under the auspices of the Italian Society for Endoscopic Surgery and New Technologies (SICE). The aim of this multicentre study was to analyse various aspects of the treatment that are still under discussion, such as the extension of the laparoscopic indications in cases of malignancy, independently of the associated splenomegaly, patient selection and operative techniques. A retrospective review of 379 patients undergoing laparoscopic splenectomy for haematological diseases from February 1, 1993, to September 15, 2005, was conducted. Data were collected from the 18 italian centres participating in the IRLSS. The mean length of surgery was 140 minutes (range: 25-420). Conversion was necessary in 25 cases (6.6%), and at least one accessory spleen was found in 30 patients (8%). The mean spleen weight was 1200 g (range: 85-4500). Perioperative death occurred in two cases (0.5%). There were no complications in 312 patients (82.3%), with a mean hospital stay of 5.5 days (range: 2-30). Morbidity occurred in 67 patients (17.8%), mainly consisting in transient fever (n = 22), pleural effusions (n = 16), and actual or suspected haemorrhage (n = 14), requiring re-intervention in 7 patients. This first study carried out on the IRLSS data shows that laparoscopic splenectomy may constitute the gold standard for haematological diseases with a normal-sized spleen. The low morbidity and mortality rates suggest that laparoscopic splenectomy can be successfully proposed also for splenomegaly in haematological malignancies.

Adolescent↗
PubMed1991

[Effect of splenectomy on the dynamics of allergic symptoms and the level of IgE in the complex treatment of children with liver cirrhosis].

Overall 21 children suffering from active liver cirrhosis were examined for the dynamics of allergic symptoms and IgE before and after splenectomy. The IgE level was measured 2-4 weeks, 3-11 months and 1-5 years after splenectomy. All the children received glucocorticosteroid therapy followed by the administration of maintenance therapy. It has been shown that splenectomy as one of the pathogenetic forms of therapy of active liver cirrhosis produces a decrease in blood IgE and in the incidence of allergic manifestations in addition to the clinical effect and amelioration of liver function.

Child↗
PubMed1991

[The combined therapy of stage-II lymphogranulomatosis: the effect of splenectomy and the time period for achieving full remission on treatment efficacy].

In 1982-1986, 72 patients with stage II lymphogranulomatosis received combined treatment according to the following program: 3 cycles of polychemotherapy in accordance with the CVPP scheme plus radiation of all the lymphatic collectors above the diaphragm up to the total radiation dose 35 Gy plus 3 cycles according to the CVPP. Splenectomy was provided to 45 patients; spleen impairment was revealed in 13. The median observation period reached 67 months. Both short- and long-term results of the treatment were analyzed. Neither splenectomy nor specific impairment thereof exerted any effect on the treatment results of this patients' group. The predominance of a number of "favourable" prognostic factors in splenectomized patients produced no effect on the treatment efficacy. It is concluded that in this patients' group, splenectomy is not advisable. A significant relationship was discovered between both survival and duration of the relapse-free course and the times of complete remission attainment. In patients, in whom complete remission was ascertained after 3 cycles of polychemotherapy and before radiotherapy onset, the 7-year survival amounted to 100% whereas the 7-year relapse-free course was recorded in 98% of cases, which is significantly higher than in patients, in whom only partial remission was attained by that time--78 and 68%, respectively (p less than 0.05).

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Effect of splenectomy on the development of neonatal lymphoid organs transplanted to animals of varying age].

The effect of splenectomy on the development of newborn thymus and spleen grafted under the kidney capsule of young and old mice has been investigated. Preliminary splenectomy is shown to increase cell counts in grafted spleen that is more conspicuous in young recipients as compared with old ones. This result suggests a decrease with age in the inhibitory effect of the host spleen on the maturation of spleen grafted from newborn donor. Combined transplantation of newborn thymus and spleen has revealed a decrease of cell counts in the donor spleen grafted to the young splenectomized recipients and, on the contrary, increase of this parameter in old ones. Immune response in donor spleen with combined transplantation of the thymus to the old splenectomized recipients is much higher as compared with the same parameter in recipient without splenectomy. It is concluded that partial destruction of the old immune system is essential for its correction.

Aging↗
PubMed1991

Splenectomy attenuates the inappropriate diuresis associated with tumor necrosis factor administration.

Tumor necrosis factor (TNF) is an important mediator of the systemic response to gram-negative sepsis and endotoxemia. We studied the renal effects of a sublethal TNF infusion in dogs (0.54 = 10(5) international units per kilogram of body weight during a six hour period). The TNF-infused dogs (n = 4) had marked polyuria and natriuresis in comparison with those in the control group (n = 12) (urine output, 35.3 +/- 4.1 versus 3.7 +/- 0.5 millimeters per kilogram per six hours p less than 0.01; sodium excretion, 2.82 +/- 0.27 versus 0.75 +/- 0.19, p less than 0.01). To evaluate the role of the spleen in this response, seven dogs that had splenectomy were infused with TNF. Splenectomy abolished both the polyuria and the natriuresis; this could not be explained by the differences in fluid balance or in hemodynamic or metabolic alterations. Treatment with ibuprofen given intravenously (12.5 milligrams per kilogram 40 minutes before and three hours after the beginning of TNF infusion) in eight dogs that did not undergo splenectomy also abolished these renal effects. Prostaglandin 2 (PGE2) concentrations in selected blood samples from the splenic vein did not increase with TNF infusion, excluding circulating PGE2 as a possible mediator of the renal effects. The results of these studies indicate that, during septic challenge or severe inflammation, the spleen participates in signaling the kidney to increase water and sodium excretion. These renal events are mediated through the cyclo-oxygenase pathway.

Analysis of Variance↗
PubMed1991

The spleen and splenectomy.

After 1940, the number of splenectomies performed in the United States and elsewhere increased rapidly. Splenectomy for Banti's disease and malaria decreased gradually into disrepute. Removal of the spleen for idiopathic thrombocytopenic purpura, congenital spherocytic anemia and acquired hemolytic anemia became accepted practice. However, debate still continues regarding the proper indications for splenectomy in Gaucher's disease, Felty's syndrome and leukemia.

Anemia, Hemolytic, Autoimmune↗
PubMed1991

[Studies on post-splenectomy infection and immune activation by muramyl peptide. A new concept in the prevention of severe infections].

The existence of the overwhelming postsplenectomy infection syndrome in adults after traumatic splenectomy is discussed controversially. In this study the effects of splenectomy and spleen-preserving operations on outcome of experimental pneumococcemia of the pig were analyzed. Furthermore, the effect of the monocyte activator MTP-PE was assessed. Splenic operations had no influence on the used criteria of sepsis. Pretreatment with MTP-PE protected animals against development of septic leukocytopenia and led to an enhanced bacterial clearance. In addition, mortality of experimental sepsis was significantly decreased. Splenic preservation in adults after posttraumatic splenectomy does not seem to be warranted. On the other hand, the activator of the monocyte-macrophage-system seems to represent an effective regimen to prevent development of sepsis in high-risk patients.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMedDate not supplied

Segmental splenectomy and extraperitoneal splenic transposition with gastroesophageal devascularization in treatment of oesophageal varices. A new technique.

We evaluated segmental splenectomy and extraperitoneal splenic transposition with gastroesophageal devascularization (S.S.S.T.) in 30 patients with oesophageal varices (22 bleeders and 8 non-bleeders) and compared their results with those of 30 patients (22 bleeders and 8 non-bleeders) who underwent splenectomy and gastroesophageal devascularization in a randomised study. It was found (by endoscopy) after a follow-up period up to 3 years that after the operation S.S.S.T. the varices disappeared in 6.7%, reduced in 66.7% and did not change in 23.3% while in the compared operation of splenectomy and gastroesophageal devascularization only, oesophageal varices did not change in 90% and increased in grading in 10%. The percent reduction of portal pressure in our new S.S.S.T. technique was 30% after 9 months and 40.7%-60% after 2 years. This decreased portal pressure reading with longer follow-up period suggests that collaterals between the transposed splenic segment and the parieties may increase in number and/or caliber by increasing the blood flow through these collaterals. No recurrence of bleeding, no encephalopathy or mortality during the period of follow-up (3 years). No reenlargement of the transposed splenic segment (clinically and sonographically) up to 3 years of observation. Trans-segmental splenic venography and Digital Vascular Imaging (D.V.I.) had demonstrated collateral vessels between the transposed splenic segment and the parieties and reversed splenic blood flow. Also, D.V.I. showed a collateral vessel anastomosis with the renal parenchymal vessels (Splenorenal collateral or shunt).

Adolescent↗
PubMedDate not supplied

[Splenectomy for massive splenomegaly. Apropos of 36 cases].

Thirty-six splenectomies for splenomegaly exceeding 1000 grams are reported. The enlargement of the spleen most often was related with a malignant disease (n = 32). Cytopenia was the main indication in 14 cases, and splenectomy was contemplated for diagnosis (n = 12), initial treatment (n = 6), or due to pain (n = 3) or spontaneous rupture (n = 1). Ten patients (27.8%) had an associated surgical treatment. One patient died postoperatively (2.8%) and 12 patients presented with 14 complications (33%) usually with a rapidly favorable evolution. In 11 of 12 cases (91.6%), the operation allowed establishing the diagnosis in cases of splenomegaly with an unknown origin. Lastly, it was always effective to relieve pain and in most cases improved cytopenia. The authors conclude that the patients with massive splenomegaly are improved by splenectomy, although it most often is merely a palliative treatment in cases of malignant hemopathy.

Adult↗
PubMedDate not supplied

[Technic of partial splenectomy with linear stapler instrument (TA 90, U.S., Surgical Corps].

Seven patients have been treated by partial splenectomy, performed with TA 90 linear stapler instrument (U.S. Surgical Corp). Three patients had non parasitic cyst of the spleen, two had malignant disease and two were operated for traumatic injuries. The section and the hemostasis of the spleen was performed with the linear stapler instrument. No patient required blood unit transfusion. Postoperative course was uneventful. Partial splenectomy with the TA 90 stapler, which does not supply the complications of total splenectomy, is an easy and safe procedure. It should be more often indicated.

Colonic Neoplasms↗
PubMedDate not supplied

[Moschcowitz's disease--effect of therapeutic plasma exchange and splenectomy].

Moszkowicz's disease (thrombotic thrombocytopenic purpura), TTP, is an uncommon haematologic, neurologic syndrome which, almost regularly, terminates fatally. The disorder has a turbulent and fulminant course and is of short duration. The presented patient was treated with a combined therapeutic modality of intensive plasma exchange and subsequent splenectomy. This is the first case of successful treatment of TTP in Yugoslavia. The previous therapeutic approaches with infusions of fresh frozen plasma produced only transient or dubious responses. Clinical remissions were rare. In this patient, however, the plasma exchange with volume adjustment with the fresh frozen plasma or albumin produced restitution of the thrombocyte count to normal values and disappearance of all neurological signs and complaints. At that point surgical splenectomy was carried out with the concomitant extirpation of an accessory spleen circumstantially detected on exploration. Pathohistology of both spleens revealed typical tissue changes (disseminated hyaline and thrombocyte thrombi of small blood vessels) characteristic of Moszkowicz's disease. Following an uneventful splenectomy and discontinuation of all medicamentouse therapy the normal thrombocyte count was maintained without no sign of recurrence of neurological symptoms or manifestations.

Adult↗
PubMed1990

[The comparative efficacy of splenectomy and antilymphocyte globulin therapy in patients with aplastic anemia].

Analysis of the clinical efficacy and long-term survival of patients with grave and not grave forms of aplastic anemia, subjected to splenectomy or treated with antilymphocytic globulin has shown that in grave aplastic anemia, the clinical efficacy of antilymphocytic globulin is higher than the efficacy of the operative treatment methods. The 30-month survival can be attained in 42% of the patients given globulin and in 28% of the patients after splenectomy. In patients with grave aplastic anemia, it is recommended that the treatment be instituted from the use of antilymphocytic globulin in a dose of 15 mg/kg bw daily for 5 days, provided there are no contraindications. In patients with not grave aplastic anemia, the results of splenectomy and therapy with antilymphocytic globulin are approximately the same: the 5-year survival amounts to 94 and 93%, respectively. Therefore, the use of globulin may be recommended as a method of choice for the above patients' group, since surgical approaches to the treatment are still coupled with a high risk for the patient's life.

Actuarial Analysis↗
PubMedDate not supplied

Phenotypical characterization of lymphocyte recirculating subsets in patients undergoing splenectomy for trauma.

The spleen is a peripheral lymphatic organ where lymphocytes stop for long time during their circulation. We studied the peripheral blood lymphocyte subsets both in 30 subjects splenectomized for trauma and in 30 healthy, non splenectomized, subjects. The phenotypical characterization of lymphocyte subpopulations was performed employing monoclonal antibodies by direct immunofluorescence assays with single and double labelling. Comparing the results, we put in evidence, in splenectomized patients, an increase in all the lymphocyte subsets but one (L. G.L. Leu7+). The CD8+ population showed the major increase according with its large representation in the splenic tissue. Splenectomy induces a change in lymphocyte recirculating pool because of the loss of an important anatomical site of migration. This reduction of lymphocyte recirculating capacity can be related to a decreased efficiency in immunocompetence. In fact, many Authors showed that splenectomy is associated with several anomalies of both humoral and cellular immune response. In contrast with this, our group of splenectomized patients doesn't reveal a greater incidence of infections. We conclude that splenectomy realizes a new anatomical situation where the reduction of lymphocyte recirculating capacity can be related to a decreased statistical efficiency in immunocompetence.

Adolescent↗
PubMed1990

[Splenectomy as therapy for esophageal varices in a myeloproliferative syndrome].

We describe the history of a man aged 73 with a myeloproliferative syndrome and massive splenomegaly, who was admitted with bleeding oesophageal varices. After sclerotherapy and other conservative measures had failed to stop the bleeding, splenectomy was performed. Liver biopsy obtained at the time of splenectomy showed extramedullary haematopoiesis and no signs of cirrhosis. Six weeks after the operation no varices were present any more. Studies of the pathogenesis of portal hypertension in splenomegaly of different causes show the importance of the increased splenic blood flow as one of the main contributory causes to this specific type of portal hypertension. Therefore this type of portal hypertension can probably be cured by splenectomy, as we saw in our patient and as has been described in several case reports.

Aged↗
PubMed1988

[Thrombocytopenia and HIV: the role of splenectomy].

Severe thrombocytopenia has been diagnosed in HIV seropositive patients independently of the clinical stage of disease. In view of its immunologic origin, attempts have been made to treat this condition with drugs which have proved effective in the treatment of autoimmune thrombocytopenia, though with little or no beneficial effect to these patients. This communication deals with the observation (5-22 months) of 5 HIV seropositive patients with severe thrombocytopenia who were resistant to steroids, high dose i.v. immunoglobulin and Danazol. They all responded well to splenectomy, with only one patient relapsing after 4 months. However, 2 patients showed deterioration of the immunodeficient state: in one patient the number of CD4 lymphocytes decreased and the other died of multifocal leuko-encephalopathy 4 months after splenectomy. Based on this small series, splenectomy seems to be effective in the treatment of thrombocytopenic HIV seropositive patients. However, long-term hazards still have to be assessed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Long-term prognosis of the results of splenectomy in idiopathic thrombocytopenic purpura].

The value of selected clinical and histological parameters for the prognosis of long-term results of splenectomies was investigated retrospectively in 50 patients with idiopathic thrombocytopenic purpura 4-14 years after surgery. Two parameters showed an association to the results of splenectomy, viz. spleen follicle size as well as site of thrombocytopenia degradation. Non-responders to splenectomy (n = 7) only turned up in spleen follicle hyperplasia, never in follicle normoplasia, however (p less than 0.01), four times more frequently in mainly extralienal thrombocyte degradation, also in predominantly lienal ones (p greater than 0.05).

Adolescent↗