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PubMed1988

Segmental splenectomy using the ultrasonic surgical aspirator.

The technique described seems to significantly decrease blood loss in segmental splenectomy. Resection of the damaged splenic segments offers the potential advantage of reducing rebleeding and secondary hemorrhage from sites of repaired lacerations. Also, the viable splenic fragment that is left behind may afford protection from postsplenectomy sepsis. The ultrasonic surgical aspirator seems well suited for the purpose of segmental splenectomy in both the trauma and staging laparotomy setting.

Humans↗
PubMed1997

A case-controlled study of laparoscopic splenectomy.

BACKGROUND: The utility of laparoscopic splenectomy (LS) has not been tested in general surgical practice. This is a case controlled study comparing the clinical results and economics of L.S. and open splenectomy (OS) in a community hospital. METHODS: The outcome of a series of 15 patients undergoing LS were compared to 15 patients undergoing OS matched for diagnosis, splenic weight, age, and main co-morbidites, selected by a person independent of the project. RESULTS: In both series, the indications were immune thrombocytopenic purpura, hemolytic anemias, hairy cell leukemia and, staging for Hodgkin's disease. LS resulted in shorter hospitalization (2.3 vs 8.8 days) with fewer postoperative complications. However, the operation was 1.7 times as long, and the operating room charge 2.9 times as high, so that the total cost of LS ($18,015) was greater than that for OS ($14,524). If the cost of treatment of complications is included, then the total is the same for both at our institutions. CONCLUSION: Except for a few indications not addressed in this study, LS can be used in lieu of OS.

Case-Control Studies↗
PubMed1999

Laparoscopic splenectomy in patients with hematologic malignancies.

BACKGROUND: Although laparoscopic splenectomy (LS) for benign hematologic disease is well accepted, its role in hematologic malignancies is not clearly defined. This study examined the efficacy and feasibility of LS for hematologic malignancies. METHODS: Records were reviewed from patients who underwent LS at two university hospitals. Charts from 77 open splenectomies for malignancy (OM) during the same period were also reviewed. RESULTS: Fifty-three patients underwent LS, 22 for hematologic malignancies (LM) and 31 for benign hematologic disorders (LB). Median splenic weight was greater in the LM group (930 g) than in the LB group (164 g, P = 0.001). LM was associated with longer operations and greater blood loss than was LB. LM had a 41% conversion rate. Morbidity, mortality, and transfusion rates were similar. Median hospital stay was shorter for LM (4 days) than for OM (6 days, P = 0.001). CONCLUSIONS: LS is feasible in hematologic malignancies but is associated with increased operative time and blood loss and a high conversion rate. Morbidity and mortality, however, was similar. Shorter hospital stays for LM compared with OM may translate into earlier recovery and initiation of antineoplastic therapy.

Adult↗
PubMed1978

Alternatives to total splenectomy: two case reports.

Postsplenectomy sepsis is a serious problem with high morbidity and high mortality. Surgical alternatives to total splenectomy are being sought. This paper describes two cases where, after splenectomy, some splenic tissue was either reimplanted or was left in situ and remains functional.

Bacterial Infections↗
PubMed1982

Torsion of the wandering spleen: splenectomy or splenopexy.

Torsion of the wandering spleen is a rare condition usually unsuspected preoperatively. In previously reported cases in the past, attempts at splenopexy have failed and splenectomy has been regarded as the treatment of choice. We are presenting two children with splenic torsion. In one complete infarction of the spleen had occurred and so splenectomy could not be avoided. In the second, the spleen was viable and splenopexy was successfully performed. The clinical presentation, etiology, diagnostic procedures and management are discussed, and a surgical technique for splenopexy is described.

Child↗
PubMed1988

Does the spleen regenerate after partial splenectomy in the dog?

Four dogs underwent two thirds partial splenectomy and the remaining spleens were followed up to 6 months by radioisotope studies and finally measured at the time of sacrifice. In this study we showed that the remaining spleens after partial splenectomy did not show any signs of regeneration.

Animals↗
PubMed1997

Technical aspects of laparoscopic splenectomy in children.

Different authors reported about their experiences in laparoscopic splenectomy. The preparation of vessels and ligaments are feasable without major problems. Nevertheless the handling of the organ during the operation and during splenic extraction can be very difficult, especially in larger organs. The authors report experience with the technique of laparoscopic splenectomy and describe a new technical aspect in handling the spleen during this procedure. A loop of an umbilical band is used for retracting the organ during the preparation and placing the spleen into a sterile bag for the removal of the organ. This device helps prevent damages to the capsule caused by forceps. Large organs can be placed into the pelvis, and the bag is placed and opened in the upper abdomen. The authors used this technique successfully in seven patients. The results are compared with previous experiences.

Adolescent↗
PubMed1998

Splenectomy in a child with chronic Mycobacterium avium complex infection and splenic sequestration.

Mycobacterium avium complex infections (MAC) are being reported with increasing frequency in immunocompromised patients. When these infections become resistant to standard antibiotic therapy, treatment with interferon-gamma (IFN-gamma) can be helpful. Pain, fever, splenic enlargement, and cytopenias caused by splenic sequestration developed during IFN-gamma treatment in a 9-year-old boy and were successfully treated by splenectomy. The development of IFN-gamma-induced splenic sequestration and cytopenias in MAC-infected patients represents a new indication for splenectomy.

Anti-Bacterial Agents↗
PubMed1979

Activity of the alternative complement pathway after splenectomy: comparison to activity in sickle cell disease and hypogammaglobulinemia.

Patients with sickle cell disease and individuals who have undergone splenectomy share defects of certain host defense mechanisms and a predisposition to severe pyogenic bacterial infections. Since patients with sickle cell disease can have deficient activity of the alternative complement pathway, we have tested such activity in sera from splenectomized children and adults. A new kinetic hemolytic assay has been used, and we have compared results to those obtained with sera from patients with sickle cell disease or hypogammaglobulinemia. Sera from six of 58 splenectomized individuals (10%) had defective function of the alternative pathway, compared to 10 of 62 sera from patients with sickle cell disease (16%) and 10 of 18 sera from hypogammaglobulinemic patients (56%). Deficiency of antibody, a rate-influencing component of alternative pathway activity in this system, appears responsible for deficient activity in the hypogammaglobulinemic sera. The molecular basis for the deficiency found in sickle cell disease or after splenectomy is not clear. Defective function of the alternative complement pathway could contribute to the increased predisposition to bacterial infection that exists in these three patient groups.

Adolescent↗
PubMed1983

Intravenous use of gammaglobulin in the treatment of chronic immune thrombocytopenic purpura as a means to defer splenectomy.

Intravenous gammaglobulin was used to treat 12 children with chronic immune thrombocytopenic purpura in order to avoid splenectomy. The average rise in platelet count with initial treatment was 226,000/microliters. Currently, one patient is in remission, four patients maintain platelet counts greater than 40,000/microliters without treatment, four patients maintain platelet counts greater than 40,000/microliters with single maintenance infusions of IV IgG at four- or 10-week intervals; three patients did not respond to treatment. In nine of 12 patients, splenectomy was avoided or at least postponed. In responding patients, we were able to discontinue immunosuppressive medication. Platelet count rises with initial IV IgG therapy were correlated with both platelet antibody levels and with a better long-term outcome. Toxicity was minimal.

Adolescent↗
PubMed1984

Role of splenectomy in homozygous sickle cell disease in childhood.

60 Jamaican children with homozygous sickle cell (SS) disease underwent splenectomy, 14 for prophylaxis against recurrent acute splenic sequestration and 46 for treatment of sustained hypersplenism. Age at operation varied from 9 months to 16 years. Patients were followed up for 1 month to 27 years (median 6 years), with a total of 369 years of patient-observation. None of the 3 patients who died, at ages 2 1/2, 6 1/2, and 21 years, had received prophylaxis against infection. Overwhelming sepsis was possible but not confirmed in the first two deaths which occurred 11 months and 2 1/2 years after operation; the third died from chronic renal failure 11 years after splenectomy. After operation, there were no confirmed cases of pneumococcal septicaemia or meningitis, and the commonest clinical event was the acute chest syndrome.

Acute Disease↗
PubMed1998

Possible feedback control of white blood cells: effect of splenectomy in Felty's syndrome.

Feedback control of the white blood cell (WBC) count was analyzed in 20 cases reported by Coon, before and after splenectomy in Felty's syndrome. In only one case did the total white cell count fail to rise postsplenectomy, while in a second case the polymorphonuclear (poly) count did not exceed the preoperative value. Both of these patients had initial poly counts above 1000/mm3. If the preoperative poly count was 35% or greater of total WBC, the postoperative percentage was lower in five out of six cases. A comparison was made between pre- and postoperative poly counts, and three cases were noted to be underresponsive. However, two had a later rise in polys ('late responders'). A non-poly was defined as total WBC minus polys; a relationship was noted between pre- and post-operative non-polys, described by the difference between initial and postoperative counts. Thus, there is evidence for feedback control of the white cell count in Felty's syndrome after splenectomy.

Feedback↗
PubMed1983

[Fulminant infectious syndrome after post-traumatic splenectomy].

A 49 year old woman presented a very serious infectious state with respiratory failure, on the third postoperative day following splenectomy for a traumatic ruptured spleen. Despite massive antibiotic treatment and treatment of the respiratory failure, the patient died. The responsibility of the splenectomy in this infection with many different organisms and the failure of antibiotics is discussed.

Accidents, Traffic↗
PubMed2001

Moyamoya syndrome with spherocytosis: effect of splenectomy on strokes.

A 3-year-old male patient with hereditary spherocytosis who developed moyamoya syndrome, presenting hemiplegia, and slurred speech is reported. Transient ischemic attacks occurred repeatedly with hemolytic crises. Magnetic resonance imaging and angiography revealed bilateral occlusion of the internal carotid and middle cerebral arteries with the formation of moyamoya vessels and multiple infarctions in the basal ganglia. Although splenectomy can increase the risk of stroke, no stroke occurred after splenectomy. On aspirin and dipyridamole therapy the patient has been free of neurologic deficits and progression of the vasculopathy for 5 years. This rare observation suggests that anemic hypoxia more greatly contributes to the progression of moyamoya syndrome than postsplenectomy thrombocytosis or reduced deformability of spherocytes.

Aspirin↗
PubMed2002

Bacterial clearance after total splenectomy and splenic autotransplantation in rats.

Wistar rats submitted to isolated total splenectomy or total splenectomy combined with splenic autotransplantation were inoculated with 99mtechnetium-labeled Escherichia coli. Measurement of isotope uptake in the organs of the mononuclear phagocytic system showed a greater bacterial bloodstream clearance in rats with splenic autotransplantation. Although uptake of bacteria in the spleen was higher in the control group, the number of bacteria remaining in the bloodstream did not differ between groups. These results indicate that splenic autotransplantation preserves the phagocytic function of the spleen.

Animals↗
PubMed1998

Laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices with hypersplenism.

BACKGROUND: The combination of sclerotherapy with surgical salvage for sclerotherapy-resistant esophagogastric varices has recently received much attention, however, the longterm results after such an operation have yet to be reported. This is a preliminary report of a laparoscopic adaptation of a previously described surgical procedure for the treatment of refractory esophagogastric varices. STUDY DESIGN: Laparoscopic gastric devascularization and splenectomy (Hassab's operation) was successfully performed to treat recurrent sclerotherapy-resistant giant esophageal varices (n=4) and recurrent rebleeding gastric varices (n=6). The patients included 8 men and 2 women who ranged in age from 35 to 67 years (average, 54.2 years). The procedure and clinical results were evaluated from various viewpoints. RESULTS: The duration of the operation ranged from 200 to 400 minutes (mean+/-standard deviation; 287.5+/-66.0 minutes) and blood loss from 10 to 1,500 mL (average, 515.5+/-507.9 mL). The weight of the spleen ranged from 500 to 850 g (average 608.0+/-126.6 g). Conversion to minimal open operation with a gasless lifting method was done in 1 patient because of uncontrolled bleeding from the splenic vein. There were no other major complications either intraoperatively or postoperatively. All patients had hypersplenism; preoperative platelet counts ranged from 1.6 to 6.8 x 10(4)/microL (average, 4.5+/-2.7 x 10(4) microL) and the postoperative count was from 5.9 to 36.0 x 10(4)/microL (average, 21.7+/-11.5 x 10(4) microL). Postoperative endoscopy revealed that varices disappeared, and no patient had recurrence of the varices after operation during the mean followup period of 12.8+/-4.1 months (average, 8 to 20 months). CONCLUSIONS: The combination of laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices is considered a feasible and relatively safe surgical method for patients with hypersplenism.

Adult↗
PubMedDate not supplied

Laparoscopic splenectomy: reduction of hospital charges.

Laparoscopic splenectomy has become our procedure of choice for the surgical management of immune thrombocytopenic purpura. Hospital charges for this procedure were analyzed for 24 consecutive patients undergoing laparoscopic splenectomy. Total charges have decreased over time and average a $233 decrease per patient treated. The decreased charges are related to decreased operating room charges. Furthermore, charges are shown to be related to the length of postoperative stay. Choice of instrumentation has kept intraoperative charges for disposables stable.

Arizona↗
PubMed1999

Functional, life-threatening disorders and splenectomy following liver transplantation.

UNLABELLED: Splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 +/- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.

Acute Disease↗