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PubMed2002

[Laparoscopic splenectomy--indications, specifics of surgical procedures and surgical technics].

The surgical management of splenic disorders has changed considerably over past few years. The increased use of laparoscopic approach for general surgical problems has prompted surgeons to investigate feasibility of laparoscopic splenectomy. However, some unique anatomical features of disordered spleen may limit the application of laparoscopic techniques for this procedure. In this article we analyzed indications for laparoscopic a surgery of the spleen, some surgical particularities of laparoscopic splenectomy, as well as the techniques to accomplish this procedure.

Contraindications↗

PubMed1993

Splenectomy abrogates the induction of oral tolerance in experimental autoimmune uveoretinitis.

Oral administration of uveitogenic antigens inhibits the development of experimental autoimmune uveoretinitis (EAU) and the cellular immune response initiated by these antigens. The mechanism of oral tolerance is not completely clear, but accumulating data indicate that suppressor cells are actively involved in this process. The spleen is known to harbor suppressor cells and their precursors and the present study was aimed at testing the role of this organ in the induction of oral tolerance by S-antigen (S-AG). We report here that: (a) splenectomy abrogated the induction of oral tolerance; unlike in sham operated controls, feeding with S-Ag did not inhibit the development of EAU in splenectomized rats; (b) splenectomized rats responded with higher cellular immune responses than did sham operated controls, but feeding with S-Ag inhibited these responses in both groups of animals; (c) splenectomy also abrogated the adoptive transfer of tolerance: EAU induction was inhibited in sham operated recipients of splenocytes from S-Ag fed donors but not in the splenectomized recipients. The data thus indicate that the spleen plays an important role in the induction of oral tolerance, perhaps by acting as the site for induction and/or amplification of cells with suppressor activity.

Animals↗

PubMed1988

Treatment of the thalassemia syndrome with splenectomy.

Splenectomy was performed on 152 patients with thalassemia (thal), including 90 cases with Hb H disease, 48 cases with homozygous beta-thal, and 14 cases with Hb E-beta-thal. The therapeutic effect in Hb H disease was 83.3%, and 32.3% in Hb E-beta-thal and beta-thal. In Hb H disease, the hemoglobin (Hb) level increased 30 g/l in 14 of 29 cases. After splenectomy, the life-span (T1/2) of 51Cr RBC in Hb H and Hb E-beta-thal increased to 18.2 +/- 2.6 and 18.2 days, respectively. The number of inclusion (Heinz) bodies attached to the RBC membrane increased after surgery. The interdermal delayed supersensitivity reaction became negative in seven of 26 cases of Hb H disease; the IgG also decreased after surgery. The number of PAS positive foam cells in the spleen correlated to Hb level after surgery. Infection is a common complication.

China↗

PubMed1981

Experimental Babesia microti infections in Macaca mulatta: recurrent parasitemia before and after splenectomy.

To learn more about the course of Babesia microti infections in primates, six Macaca mulatta monkeys with blood-induced B. microti infections were followed for 270 days with regular thick blood smears. Three of the monkeys experienced from 1--3 recurrences of parasitemia defined here as greater than or equal to 200 organisms/mm3 blood. Following splenectomy on day 297, parasitemia recurred in all animals, reaching levels of 1.9 x 10(5) to 2.7 x 10(6) organisms/mm3, and was associated with a moderately severe hemolytic anemia. These findings suggest that similar recurrences of parasitemia may occur in human cases, and that splenectomy may present a risk to persons with a past history of B. microti infection.

Animals↗

PubMed1982

Quartan malaria following splenectomy 36 years after infection.

Quartan malaria developed following splenectomy 36 years after infection in a 63-year-old hypertensive man. The patient underwent nephrectomy because of left renal calculus, increasing proteinuria and hypertension. Splenectomy was done additionally because metastasis of renal tumor to the spleen was suspected at the operation. Attention is drawn to the long silent infection with Plasmodium malariae and to the importance of the spleen in malaria.

Humans↗

PubMedDate not supplied

Partial splenectomy in the dog: a comparison of stapling and ligation techniques.

Partial splenectomy was performed in 17 adult dogs by using either surgical stapling instrumentation or conventional suturing techniques. Blood loss was minimal as determined by clinical observation and comparison of packed cell volumes and total protein levels before and after surgery. Surgical stapling instrumentation or suturing techniques may be used safely for partial splenectomy in the dog; however, the stapling technique significantly decreases operative time.

Animals↗

PubMed2001

Role of Doppler sonography in the evaluation of accessory spleens after splenectomy.

OBJECTIVE: Splenectomy influences the Doppler blood flow pattern in the splenic artery. Blood flow in this vessel might return to normal if an accessory spleen increases in size after splenectomy. Our objective was to evaluate the resistive index of the splenic artery depending on the presence or absence of a hypertrophic accessory spleen in splenectomized patients. METHODS: The resistive index of the splenic artery was evaluated by duplex Doppler sonography in 19 splenectomized patients (8 with a hypertrophic accessory spleen) and in 8 healthy volunteers. The resistive index was measured within 3 cm of the origin of the splenic artery, and 3 different measurements were averaged. The presence or absence of a hypertrophic accessory spleen was diagnosed on the basis of sonography, computed tomography, magnetic resonance imaging, or scintigraphy, as well as by the presence or absence of Howell-Jolly bodies on a peripheral blood smear. RESULTS: The resistive index of the splenic artery in the splenectomized patients without a hypertrophic accessory spleen (mean +/- SD, 0.82 +/- 0.06; n = 11) was significantly (P < or = .0001) higher than in splenectomized patients with a hypertrophic accessory spleen (0.63 +/- 0.06; n = 8) and in control subjects (0.63 +/- 0.05; n = 8). CONCLUSIONS: In the splenectomized patient, a hypertrophic accessory spleen is associated with a normal resistive index in the splenic artery.

Adult↗

PubMed1976

The role of the spleen and splenectomy in autoimmune hemolytic disease.

The relationship of the spleen to the red cell in AHDW is determined by the characteristics of the surface protein coating of the red cell, rather than by a pathologic change in the reactivity of the spleen. The behavior of the spleen is essentially a passive response to red cells with abnormal properties. The critical properties are incompletely defined, but probably include cell shape, and perhaps more importantly, the intrinsic properties of the cell membrane. The effects produced by the spleen are mediated partly by the filtration mechanism of the splenic sinus walls, and partly by the more specific effects of cell-to-cell adhesion between the pulp macrophages and the red cells. The outcome is more complex than former concepts of red cell destruction encompassed: delay in cell passage produces cell pooling in the unfavorable environment of the splenic pulp, and there is microfragmentation, cell sphering, and partial phagocytosis, in addition to cell destruction with erythrophagocytosis in situ. Prediction of the degree of dependence of hemolysis on the spleen prior to splenectomy remains an area of uncertainty. Commonly, the decision for splenectomy is determined circumstantially, but current concepts would anticipate that the most relevant data would relate to the dimensions of splenic pooling, and the quantity and class of immunoglobulin present on the cells.

Anemia, Hemolytic, Autoimmune↗

PubMedDate not supplied

Laparoscopic splenectomy for hematological disorders. Our experience in adult and pediatric patients.

Laparoscopic splenectomy has gained increasing acceptance in the surgical management of a variety of splenic disorders, in particular hematological diseases. In this series, we report our experience with 20 patients (male:female ratio of 4:16 with median age of 16 years, range 5-49 years) who underwent this procedure because of ITP in 9 cases, spherocytosis in 7 and Cooley disease, sickle cell anemia, dyserythropoietic and hemolytic anemia in one case each. The patient was placed in a supine position using a fourtrocars technique. We did not perform pre-operative splenic artery embolization in any case. Spleen lower pole and its posterolateral attachments were dissected first, using electrocautery and endoclips. Vascular hilar isolation was achieved with an EndoGIA stapler and the spleen was removed by morcelation within a retrieval bag (16 cases) or via a 4-5 cm left subcostal incision (4 cases). One patient required conversion to open technique (conversion rate 5 %), because of uncontrolled bleeding from splenic hilum. Mean operative time was 165 min (range 100-240 min), mean splenic size was 13.5 cm (range 11-20 cm), with weight ranging between 140 and 1060 g and estimated blood loss was 151 ml (75-280 ml). No patient required a blood transfusion. Median postoperative hospital stay was 4 days (range 3-8 days). Postoperative complications occurred in 2 patients (10%), with no mortality rate in this series. Regarding the low complication rate and the advantages of a small abdominal trauma in the postoperative period, such as less postoperative pain, faster hospital discharge and better cosmetic results, the laparoscopic approach for elective splenectomy in hematological disorders has a substantial benefit for the patient.

Adolescent↗

PubMedDate not supplied

[A splenic autograft in posttraumatic splenectomies].

BACKGROUND AND AIMS: The authors report their experience regarding the use of autologous splenic transplantation in post-traumatic splenectomy unable to be treated using conservative surgery. After reviewing the international literature on the subject, they report a retrospective survey of cases treated from January 1992 to December 1996. METHODS: Owing to the particular logistic location of the hospital in an area with a high density of industry and at the crossroad of major road and rail routes, a total of 56 patients were admitted to the Emergency Ward suffering from abdominal trauma in 4 years. The patients included in this study could not be treated using conservative surgery: the study group included 15 patients aged between 14 and 76 years old. The surgical technique consisted of the graft of sections of splenic pulp in omental pockets, subsequently marked using metal clips. In order to evaluate splenic immunological function a complete hemochromocytometric examination was performed in each patient at the same time as emergency preoperative tests consisting of peripheral blood strip and pitted cells (PC) assay. This was followed by postoperative evaluations at weekly intervals, including platelet count, Howell-Jolly bodies assay (HJb), immunoglobulin M assay and hepatosplenic scintigraphy using erythrocytes marked with 99m-Technetium pertechnetate (99mTc). RESULTS: An adequate functional recovery of splenic tissue was achieved in all patients with partial recovery of hemocatheretic and immunological function. CONCLUSIONS: The authors' clinical experience confirmed the data inferred from animal experiments: the simplicity of the preparation technique and the autologous transplantation of splenic pulp in the absence of major complications confirms the possibility of applying this method in all splenectomies performed under emergency conditions.

Abdominal Injuries↗

PubMedDate not supplied

Laparoscopic splenectomy for splenic artery aneurysm.

Two cases undergoing a laparoscopic splenectomy for the treatment of a splenic artery aneurysm are herein reported. This lesion is relatively rare. Surgical treatment is indicated for such cases since approximately 10% of these aneurysms tend to rupture which thus results in fatal hemorrhaging. Both cases demonstrated aneurysms measuring more than 2 cm in diameter based on the ultrasonography, computed tomography and celiac angiography findings and, as a result, a laparoscopic splenectomy was thus prophylactically performed. This procedure is the preferred technique for high risk patients, such as those with chronic renal failure, as observed in case 1, since patients can be spared the disadvantages of undergoing a laparotomy.

Aneurysm↗

PubMedDate not supplied

Halitosis: a delayed complication of splenectomy.

Subphrenic abscess is a recognised complication of splenectomy, but fistulation into the stomach is extremely rare. This report describes a delayed complication of splenectomy presenting as offensive and socially disabling halitosis.

Halitosis↗

PubMed1976

Splenectomy in chronic myelogenous leukemia.

There were no deaths or major complications in three chronic myelogenous leukemia patients in group 1 who were selected under well controlled conditions and had the spleen removed. Intensive chemotherapy in the treatment of chronic myelogenous leukemia patients who undergo splenectomy remains to be resolved. Well controlled prospective clinical trials are now being conducted to evaluate the value of splenectomy in chronic myelogenous leukemia.

Adult↗

PubMed2000

[Allogeneic bone marrow transplantation for primary myelofibrosis after splenectomy].

A 46-year-old woman was given a diagnosis of primary myelofibrosis (PMF) in 1996. Because of the progression of anemia and splenomegaly, she was scheduled for allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling donor in April 1998. Cyclophosphamide and busulfan were used as the conditioning regimen. Before BMT, the patient was treated with hydroxycarbamide, which did not resolve splenomegaly. She then underwent a splenectomy, which was followed by massive portal vein thrombosis without any significant clinical outcome. After BMT, the patient obtained rapid hematologic engraftment. Moreover, the alleviation of marrow fibrosis was confirmed 4 months after BMT. We concluded that allogenic BMT can cure patients with PMF, but that the issue of splenectomy and the indications for BMT need to be evaluated further.

Bone Marrow Transplantation↗

PubMed2000

Technique for laparoscopic partial splenectomy.

Splenic preservation and conservative management are now accepted norms when dealing with splenic pathologic conditions. This case report describes the technique of laparoscopic partial splenectomy for an undiagnosed splenic lesion. A thorough understanding of splenic anatomy permits laparoscopic partial splenectomy with the resultant benefits, including a decreased risk of postsplenectomy sepsis, short hospital stay, and superior cosmesis. The success and relative ease of performing this procedure will pave the way for its future use in other selective cases involving splenic pathology.

Adult↗

PubMed2000

Laparoscopic splenectomy for splenic sequestration crisis.

Medical and surgical advances have improved the treatment of splenic sequestration crisis in pediatric patients with sickle cell disease (SCD). Rapid enlargement of the spleen can result from sickled blood cels being trapped in the spleen, which can be life threatening. The laparoscopic splenectomy procedure using the lateral approach has been adapted successfully for the pediatric patient since 1993. Children with SCD who have a history of a splenic sequestration crisis usually are scheduled for an elective splenectomy procedure after the first documented crisis to reduce the risk of death. Some key benefits of this new surgical approach include a shortened hospital stay, decreased postoperative pain, and faster recovery and return to normal activities for the child with SCD.

Acute Disease↗

PubMed2000

The use of liposucker for spleen retrieval after laparoscopic splenectomy.

The retrieval of spleen after laparoscopic splenectomy has long been a problem. Frequently, it is necessary to extend the wound for retrieving the spleen intact and to prevent potential spillage of splenic tissue into the peritoneal cavity. We describe the application of the liposuction unit to remove the spleen piecemeal after laparoscopic splenectomy. We have found this technique easy to apply and safe, without the necessity of excessive wound extension, while preserving splenic tissue for histologic examination.

Adult↗

PubMed1999

[Preliminary report of experience with laparoscopic splenectomy in adults and children].

Laparoscopic splenectomy is effective and technically feasible for treating various hematological diseases such as idiopathic thrombocytopenic purpura (ITP), congenital spherocytosis, hemolytic anemia, and Hodgkin's lymphoma. An anterior approach to the vascular pedicle is usually described. However, in this approach to the splenic hilum, the dissection of the splenic artery is frequently difficult. The laparoscopic posterolateral approach involves dissection of the posterolateral attachments to the diaphragm, followed by the dissection and ligation of all splenic branches near the splenic parenchyma. We used it in 9 adults and 4 children: 11 patients had ITP, 1 spherocytosis and 1 Hodgkin's lymphoma. This procedure was completed in 13 patients, but in 2 it had to be converted to open surgery. Mean operating time was 3 hours and mean postoperative stay 3 days. Blood transfusion was not required and there were no postoperative complications. Laparoscopic splenectomy is safe in both adults and children, and the posterolateral approach provides excellent visualization and allows control of the branches of the splenic vein and artery in the splenic hilum.

Adult↗