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PubMed1991

Aortic valve replacement and splenectomy in a patient with chronic idiopathic thrombocytopenic purpura--preoperative management with high-dose gamma-globulin.

We report the management of a patient with chronic idiopathic thrombocytopenic purpura and severe aortic valvular disease. Preoperative intravenous high-dose gamma-globulin administration was employed, and aortic valve replacement combined with splenectomy were performed during the same operation. The platelet count at admission was 34,000/mm3 and increased to 146,000/mm3 after the gamma-globulin therapy. Platelet transfusion at the end of the cardiopulmonary bypass was considered no longer necessary in the postoperative period, because the platelet count increased quickly after the procedure. The postoperative course was uneventful. We believe that open heart surgery and splenectomy can successfully be performed simultaneously in a patient with chronic idiopathic thrombocytopenic purpura treated with high-dose gamma-globulin therapy.

Aortic Valve Insufficiency↗
PubMed1980

[Caesarean section with splenectomy in a patient with idiopathic thrombocytopenic purpura (author's transl)].

We report a patient who had a marked exacerbation of idiopathic thrombocytopenic purpura at 33 weeks of pregnancy. The platelet count rose in response to treatment with high doses of glucocorticoids and it was possible to allow the pregnancy to continue until 39 weeks. The patient was then delivered by elective Caesarean section and she had a splenectomy at the same time. A transfusion of platelets was administered as soon as the splenic vessels had been clamped. The resultant excess of platelets necessitated treatment with acetylsalicylic acid. At 18 months after Caesarean section and splenectomy the thrombocytopenia had not recurred. The infant had transient neonatal thrombocytopenia but required no active treatment for this.

Adult↗
PubMed1999

Peritoneal irrigation with povidone-iodine solution after laparoscopic-assisted splenectomy significantly decreases port-tumor recurrence in a murine model.

PURPOSE: The development of port-wound tumor recurrences has raised questions regarding the safety of laparoscopic methods for the resection of malignancies. The cause and the incidence of abdominal-wall tumor recurrences remain unknown. It is also not clear how to avoid or lower the incidence of port-tumor recurrences. The purpose of the current study was to determine the impact of abdominal irrigation with povidone-iodine on the port-wound tumor incidence in a murine model. METHODS: A splenic tumor model was used for this study. To establish splenic tumors, female BALB/c mice (N = 48) were given subcapsular splenic injections of a 0.1 ml suspension containing 10(5) C-26 colon adenocarcinoma cells via a left-flank incision at the initial procedure. Seven days later, the animals with isolated splenic tumors (100 percent) were randomly assigned to one of three groups: 1) control, 2) saline irrigation (saline), or 3) povidone-iodine irrigation. All animals underwent laparoscopic mobilization of the spleen using a three-port technique, intra-abdominal crushing of the tumor, followed by an extracorporeal splenectomy via a subcostal incision. No irrigation was performed for control group animals. In the saline irrigation group, the subcostal incision was closed and pneumoperitoneum was re-established. The abdominal cavity was irrigated with 5 ml of normal saline for 60 seconds before instrument removal. In the povidone-iodine irrigation group, similar abdominal irrigation was performed, using 0.25 percent povidone-iodine. Attempts were made to recover completely the irrigation for both irrigation groups. Seven days after the splenectomy, animals were killed and inspected for abdominal-wall tumor implants. RESULTS: There were significantly more animals with at least one port-tumor recurrence in the control group than in the povidone-iodine group (P = 0.007). Although not statistically significant, the number of animals with port-wound tumors was higher in the saline group than in the povidone-iodine group (P < 0.08). There was no significant difference between the saline group and the control group. When each port site was considered independently, the incidence of port-wound tumors (number of ports with tumors per total number of ports) was significantly lower in the povidone-iodine group than in both the control (P = 0.00001) and saline groups (P = 0.03). The incidence of port-wound tumors was also significantly lower in the saline group compared with the control group incidence (P = 0.03). CONCLUSIONS: Abdominal irrigation with dilute povidone-iodine solution significantly reduced the number of animals with port-tumor recurrences. Abdominal irrigation with saline was also effective in reducing the incidence of port-wound tumor formation when each port was considered separately. However, povidone-iodine irrigation was much more effective than saline irrigation in preventing port-wound tumor formation.

Adenocarcinoma↗
PubMed1984

Bidirectional effects of splenectomy on the growth of syngeneic tumor in mice.

The effects of splenectomy on tumor growth following inoculation with a relatively large number of cells (1 X 10(7) ) and a smaller number of cells (5 X 10(5) ) of Meth I tumor were studied. When 1 X 10(7) tumor cells were inoculated, tumor growth in splenectomized mice was depressed, while tumor in sham-operated mice grew progressively. On the contrary, when 5 X 10(5) tumor cells were inoculated, the tumor take was lower in sham-operated than in splenectomized mice. The spleen cells from mice inoculated with either a large or small number of tumor cells, showed an equally potent cytotoxic activity, but no detectable suppressor cell activity. On the other hand, the activity of immunosuppressive factor was detected in sera from mice inoculated with 1 X 10(7) tumor cells, but not in those given 5 X 10(5) cells. The effect of splenectomy on tumor growth is, thus, bidirectional, depending on the dose of tumor cells inoculated.

Animals↗
PubMed1999

Laparoscopic splenectomy for a giant splenic epidermoid cyst: report of a case.

The use of laparoscopic splenectomy has increased in recent years, primarily for patients with idiopathic thrombocytopenic purpura (ITP). We describe herein the first known case of a laparoscopic splenectomy to be performed in Japan for a patient with a giant splenic epidermoid cyst. A 26-year-old woman presented to our hospital with the major complaint of a feeling of abdominal fullness. Prior to surgery, an ultrasound-guided splenic cyst puncture was conducted for diagnostic purposes as well as to reduce the size of the cyst. The carbohydrate antigen 19-9 (CA 19-9) level was found to be elevated in the cystic contents and in the serum. Under laparoscopic guidance, the splenic vessels were ligated using a device for extracorporeal ligation, then divided. After the resected spleen had been placed in a retrieval bag, it was delivered out of the abdominal cavity without fragmentation. Following surgery, the patient's serum CA 19-9 level returned to normal. Splenic epidermoid cysts are most often encountered in young women, and laparoscopic surgery to remove cysts of this type is both minimally invasive and excellent from a cosmetic standpoint. Thus, laparoscopic surgery should be considered as the method of choice for the majority of patients diagnosed with a splenic epidermoid cyst.

Adult↗
PubMedDate not supplied

Laparoscopic splenectomy--technical aspects.

Since the recent development of endoscopic cholecystectomy various other digestive disorders have been treated endoscopically. Using the endo-GIA stapler the authors report a case of laparoscopic splenectomy. Five trocar sheaths were used. Once detached, the spleen was cut into fragments in a plastic bag intraabdominally, which allowed its removal. Splenectomy was performed for a girl who had an autoimmune thrombocytopenic purpura (ITP). No operative transfusion was required. The patient was discharged after an uncomplicated postoperative recovery. The cosmetic result is good.

Autoimmune Diseases↗
PubMed2002

Abnormal NK cell lymphocytosis detected after splenectomy: association with repeated infections, relapsing neutropenia, and persistent polyclonal B-cell proliferation.

We report the case of a boy with hereditary spherocytosis who presented with mild microcytic hypochromic anemia and recurrent leg ulcers that had been present since childhood. Chronic natural killer (NK) cell and B-cell lymphocytosis was detected 1 year after therapeutic splenectomy during investigation of recurrent episodes of neutropenia and persistent lymphocytosis. NK cells proved to be abnormal at immunophenotyping studies, and B-cells were polyclonal and displayed a normal immunophenotype. Genotypic analysis of T-cell receptor (TCR)-beta and TCR-gamma genes showed a germ-line pattern. The clinical course of this patient was characterized by multiple pulmonary infections and amygdalitis. We discuss the potential roles of persistent immune stimulation due to chronic hemolysis and severe leg ulcers and of splenectomy in the origin of NK cell lymphocytosis and the relationship between NK cells and recurrent infections, relapsing neutropenia, and polyclonal B-cell response.

B-Lymphocytes↗
PubMed1999

Laparoscopic vs open splenectomy in the management of hematologic diseases.

BACKGROUND: Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative stay and more rapid return to full activity are the primary advantages of LS. METHODS: Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive open splenectomies (OS) (group 2) were performed for hematologic diseases. RESULTS: The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach. CONCLUSIONS: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach. The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.

Adolescent↗
PubMed2001

[Laparoscopic splenectomy: new techniques and indications].

Over the recent years laparoscopic splenectomy has become the preferred approach for the treatment of many conditions requiring splenic removal. At first limited to small spleens and to benign hematologic disorders, this procedure is now used for a variety of indications. Enlarged spleens are possible to be removed laparoscopically, although this is still a demanding procedure. Two factors facilitated the technique and contributed to its wide acceptance: 1) Change in the technique originally used, by positioning the patient in right lateral decubitus, and approaching the spleen from a postero-lateral direction. 2) The development of new technologies to dissect and divide tissues and vessels, including the ultrasonic shears and the laparoscopic linear stapler. In this article we review the current indications for laparoscopic splenectomy, as well as the techniques to accomplish this procedure.

Humans↗
PubMed1998

[A fulminant course of infection after splenectomy].

A report is given of two patients with a history of splenectomy many years previously due to traumatic rupture. No vaccination was given to either patient. From a state of good health, both patients developed fulminant, therapy-resistant sepsis with proof of Streptococcus pneumoniae in the blood culture. Autopsy findings were similar to Water-house-Friderichsen-syndrome. In conjunction with the history of splenectomy, the final pathological diagnosis was a so-called OPSI syndrome. This postsplenectomy sepsis is discussed further.

Adrenal Glands↗
PubMed1998

Laparoscopic splenectomy for benign and malignant hematologic diseases: 35 consecutive cases.

The feasibility and safety of laparoscopic splenectomy (LS) has been shown for a variety of diseases with small or moderately enlarged spleens. Immune thrombocytopenic purpura thus has become the typical indication for LS, although few data are available to demonstrate any superiority of the laparoscopic approach over conventional surgery for this indication. We retrospectively analyzed 35 cases of LS for benign (22 patients) or malignant (13 patients) hematologic disorders. LS was attempted irrespective of the volume of the spleen. The overall operative mortality rate was 2.9%, and complications occurred in 23% of all patients. The conversion rate was 9%, and accessory spleens were found in 17% of patients. Although the patients with malignant disease were significantly older, were higher operative risks (ASA score), had much larger spleens, and required longer operative times, more conversions to laparotomy, and more blood transfusions than patients with benign disease, their mortality and complication rates and the duration of their hospital stays were not significantly different from those with benign disease. They also compare favorably with the results of conventional surgery for the same indications. Patient selection, operative technique, and outcome of laparoscopic and conventional splenectomy are discussed with regard to the literature. Although the experience with LS for these indications is still limited, the reported results indicate that LS may be as beneficial for patients with malignant as for those with benign hematologic conditions.

Adult↗
PubMed1998

Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging.

We report the results of a prospective series of 60 consecutive splenectomies for hematologic disorders performed between February 1995 and May 1996. The portal venous flow of all the patients (34 men and 26 women with a mean age of 54.1 years) was systematically studied before and after intervention with Doppler color imaging (on the day before the intervention and on the 7th and 30th postoperative days). The objective of this study were to determine the real frequency of asymptomatic portal or splenic venous thrombosis (PSVT) after hematologic splenectomy. The intervention began with exteriorization of the spleen and the tail of the pancreas; ligation of the splenic vein was performed close to its junction with the inferior mesenteric vein. Twenty-three complications (38.3%) were noted with three deaths (5%). One symptomatic PSVT (1.6%) and three asymptomatic PSVTs (6.7%) were diagnosed and treated with no deaths. Three risk factors of PSVT, recognized by all the authors, were present in these four cases: large splenomegaly, thrombocytosis, or myeloproliferative disorder. The systematic ultrasonographic (US) examinations increased the frequency of diagnosis of PSVT sevenfold during the perioperative period. Patients with marked splenomegaly associated with lymphoma, chronic lymphocytic leukemia, or myeloid metaplasia probably require systematic US monitoring during follow-up, but this must be determined by further study.

Adult↗
PubMed2002

Splenectomy in patients with mixed myelodysplastic/myeloproliferative disease.

According to the classification of the World Health Organization, the designation myelodysplastic/myeloproliferative disorder, unclassifiable may be applied to cases that have clinical, laboratory, and morphologic features that support a diagnosis of a myelodysplastic syndrome (MDS) as well as a myeloproliferative disorder (MPD), but that do not meet the criteria for any of the other entities included in the MDS/MPD category [3]. In this paper we report on two Caucasian patients with unclassifiable myelodysplastic syndromes with proliferative characteristics. Both patients were suffering from thrombocytopenia and splenomegaly and underwent splenectomy. The weight of the spleen specimens was more than 2000 g. Histopathology findings revealed a marked infiltration of the spleen with extramedullary hematopoiesis. After surgery, one patient showed a rapid increase of platelets in peripheral blood and developed severe thrombocytosis. In the other case, the patient was suffering from a decrease of platelets and died in hypovolemic shock caused by gastrointestinal bleeding. In summary, these two cases demonstrate the difficulties of prognosis and treatment in patients with mixed myelodysplastic/myeloproliferative disorders. Additionally, we indicate the potential positive outcome of splenectomy as ultima ratio in patients with these hematological features and severe thrombopenia.

Blood Cell Count↗
PubMed2003

Efficacy and safety of splenectomy in adult chronic immune thrombocytopenia.

For patients with adult chronic immune thrombocytopenia (ITP) splenectomy (SE) is a highly effective treatment, but there are still uncertainties regarding the long-term efficacy and safety. We evaluated the long-term efficacy and safety of SE in 48 consecutive adult patients with chronic ITP (26 women, 22 men) who underwent SE between 1990 and 2001 at the General Hospital in Vienna, Austria. All patients had no remission after steroid treatment and were steroid dependent. The median age at the time of SE was 44 years (range: 16-77 years). Of 48 patients, 37 achieved a complete remission (CR, platelet count >100 x 10(9)/l), 8 a partial remission (PR) (platelet count 30-100 x 10(9)/l), and 2 had no response (NR). The probability of the overall survival was 98% at a median postsplenectomy observation time of 3.5 years. Seven patients with CR and four patients with PR relapsed. There were no relapses after 1 year. The probability of continuous complete remission (CCR) at 10 years was 79%. The probability of having a platelet count of >100 x 10(9)/l or >30 x 10(9)/l was 61% and 67%, respectively, at 5 and 10 years after splenectomy. Of the 11 relapsed patients, 5 had a second CR ( n=3) or PR ( n=2). The postoperative platelet count was the best predictor for a long-term remission. All patients with postoperative platelet counts >250 x 10(9)/l remained in CR. Patients aged >45 years had a similar success rate as compared with younger patients. Three patients had infections (one pneumonia and two fever of unknown origin) requiring hospitalization, but none had overwhelming septicemia.

Adolescent↗
PubMed1997

[Fulminant infection outcome after splenectomy].

A report is given of two patients with a history of splenectomy many years previously due to traumatic rupture. No vaccination was given to either patient. From a state of good health, both patients developed fulminant, therapy-resistant sepsis with proof of Streptococcus pneumonlae in the blood culture. Autopsy findings were similar to Waterhouse-Friderichsen-syndrome. In conjunction with the history of splenectomy, the final pathological diagnosis was a so-called OPSI syndrome. This postsplenectomy sepsis is discussed further.

Adrenal Glands↗
PubMed2004

Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients.

AIM: The preoperative detection of accessory spleen (AS) is still a very important and serious problem. The aim of the study was to assess the reasons for failure and the long-term results of laparoscopic splenectomy (LS) in patients with idiopathic thrombocytopenic purpura (ITP). METHOD: Fifty-eight ITP patients underwent LS between June 1998 and December 2002. There were 42 women and 16 men. Preoperatively, we performed computed tomography (CT) and sonography to evaluate the size of the spleen and possibly to recognize the presence of the accessory spleens, which were found preoperatively in three cases. RESULTS: Intraoperatively, ASs were found in the course of laparoscopy in six cases overall, three preoperatively false negative. During follow-up (median time 31 months), in three patients the low platelet count was recognized, respectively after 5 months and 1.5 and 1.8 years. In all those cases scintigraphy was performed and in one case the residual accessory spleen, missed both in preoperative examination and during laparoscopy, was revealed. In two other patients, in spite of thrombocytopenia, no residual spleens were found. CONCLUSION: We conclude that the problem of accessory spleens can be managed by careful videoscopic examination of the abdominal cavity during splenectomy, while the use of preoperative imaging techniques in detection of accessory spleens is still limited by the insufficient sensitivity of the examination.

Adult↗
PubMed2002

Splenic cysts: a new approach to partial splenectomy.

Laparoscopic partial splenectomy of a splenic cyst in a 19-year-old female patient is discussed. We successfully performed a laparoscopic partial splenectomy and achieved meticulous hemostasis using an Endo-GIA stapling device. The patient tolerated the procedure well and was discharged on postoperative day 2. At this writing, she has been followed for 30 months without cyst recurrence. Minimally invasive surgery provides an alternative to conventional surgical procedures, with a short hospital stay and without the added morbidity of laparotomy.

Adult↗
PubMed2002

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP).

BACKGROUND: Although the short-term benefits of laparoscopic splenectomy (LS) have been well documented, long-term follow-up data of patients who have undergone LS for ITP are scarce. We report our long-term follow-up data in patients who underwent LS for idiopathic thrombocytopenic purpura (ITP). METHODS: Data were obtained from a prospectively collected computer database of 52 patients who underwent LS between October 1992 and December 2000 for medically refractory ITP. Patients and their referring hematologist were contacted, and follow-up information was obtained for 45 patients. RESULTS: Fifty-two patients (27 women and 25 men) underwent LS for ITP. Median operative time was 160 min (range, 70-335); and median blood loss was 100 cc (range, 20-1500). There were seven cases of intraoperative hemorrhage (13.7%), resulting in one conversion. A second case was converted due to inadequate working space in a patient with a 26-cm spleen. Accessory spleens were found in 17 patients (32.7%). Postoperative complications occurred in three patients (5.9%). There were no deaths. Median length of hospital stay was 2 days (range, 1-12). Follow-up data were obtained in 45 patients (86.5%), with a median follow-up of 51 months. Six patients did not respond to surgery initially, and another two patients developed recurrent disease, for a remission rate of 82.2%. Nine patients underwent a damaged red blood cell scan. This group included the two patients who suffered recurrences. A positive scan was obtained in three patients (33%), one of whom was a patient with recurrent disease. This patient underwent an uneventful laparoscopic excision of residual splenic tissue but continues to require intermittent steroids to maintain platelet counts. The two other patients with a positive scan remain in remission. CONCLUSIONS: Laparoscopic splenectomy for ITP is safe and associated with low morbidity and a short hospital stay. Long-term follow-up showed that remission rates of ITP following LS are comparable to those reported in the literature on open surgery.

Adolescent↗