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PubMed1981

The spleen and splenectomy.

The present knowledge of splenic function is summarised chiefly from the point of view of the complications attendant on total splenectomy. The chief complication is overwhelming sepsis with rapid onset leading to disseminated intravascular coagulation and death. This may happen shortly after the surgical procedure or may take place after many years, even as long as 25 years. In the light of present views, it is concluded that there are few legitimate indications for splenectomy and these are listed together with points for further consideration in each patient. Even then, some splenic tissue should be preserved and the methods to achieve this are discussed.

Adult↗
PubMed1980

Effects of massive intestinal resection and splenectomy on portal pressure and thoracic duct lymph. An experimental study.

The effect of massive intestinal resection (MIR) alone and when combined with splenectomy, on portal pressure and thoracic duct lymph (TDL) flow, and protein content, was experimentally studied in a series of 12 dogs with created presinusoidal portal obstruction. MIR was associated with a significant drop in the portal pressure and TDL flow, and significant increase in TDL protein content. When splenectomy was added, more reduction of the portal pressure and TDL flow was obtained. The significance of these findings is discussed in relation to the hemo- and lymphodynamic changes in presinusoidal portal obstruction.

Animals↗
PubMed1995

Indication for splenectomy combined with total gastrectomy for gastric cancer: analysis of data on 249 gastric cancer patients.

This study analyzed intraoperative indication for splenectomy at the time of total gastrectomy, based on 249 gastric cancer patients. Data on these patients were studied with special reference to the relationship between intraoperative gross findings such as serosal invasion, tumor size, histologic patterns and nodal metastasis to the splenic hilus. Fifty-three of the 249 patients (21.3%) had a positive metastasis. The incidence of nodal metastasis to the splenic hilus was high in patients with a primary lesion in the entire stomach (26/72: 36.1%). In case of no serosal invasion of the primary lesion, there was no nodal involvement to the splenic hilus (0/42). The low incidence of nodal metastasis occurred in case of a tumor size of less than 40 mm in the largest diameter (1/60: 1.7%) and with histological findings of signet ring cell carcinoma (1/19: 5.3%). Although site and size of the primary tumor, depth of tumor penetration, and histologic findings are interdependent variables, these factors indicate probable nodal involvement to the splenic hilus and unnecessary splenectomy can be avoided.

Female↗
PubMed1994

Splenorrhaphy versus splenectomy.

Splenorrhaphy is considered a safety procedure in the traumatic splenic injury and should be attempted in all patients except when the spleen is shattered, or avulsed and in multiple concomitant injuries where splenectomy is advised. We report on 16 patients of traumatic splenic injuries from January 1988 to December 1988. In 10 patients (62.2%) splenorrhaphy was performed with catgut and omental patch reinforcement in addition to topical haemostatic synthetic material "Gelfoam" application with mortality of 10% due to unrelated causes. Splenectomy was performed in 6 patients (37.8%) with mortality of 2 patients (33.3%) due to multiple associated intra-abdominal injuries.

Adolescent↗
PubMed1995

[Influence of splenectomy on drug therapy for acute liver failure induced by D-galactosamine and lipopolysaccharide in rats].

We studied protective effects of dibutyryl cyclic AMP (DBcAMP 15 mg/kg i.p.) and OK-432 (5 KE/body), and the role of the spleen on D-galactosamine (D-Gal 500 mg/kg i.p.) and lipopolysaccharide (endotoxin: Et 0.5 mg/kg i.p.) induced acute liver failure. The survival rates were 10% in the control group (D-Gal+Et), 53% in the group I A (DBcAMP was administered at 1 hour before D-Gal administration), 79% in the group I B (Splenectomy was performed at 24 hours before D-Gal administration on the group I A), 87% in the group II A (OK-432 was administered at 24 hours before D-Gal administration), and 64% in the group II B (Splenectomy was performed at 24 hours before D-Gal administration on the group II A). GOT activities and TNF activities were significantly improved in the treatment groups, and in the group I B and group II A, they were more improved than in the group I A and group II B. In conclusion, spleen had the positive effect for OK-432 treatment, and also had the negative effect for DBcAMP treatment on acute liver failure induced by D-Gal and Et.

Animals↗
PubMedDate not supplied

[Blunt injuries of the spleen. What is the role of splenectomy?].

In an exhaustive retrospective study of splenic trauma diagnosed over a 7-year period (1986-1992) in our orthopaedic trauma centre we collected 63 cases. Splenectomy was performed in 25 patients, conservative surgery was performed in 6 and non-surgical conservative therapy was possible in 32. The large percentage of non-surgical cases was possible due to the simple clinical course in cases diagnosed late and because of careful surveillance and the precision of scanographic diagnosis. The concept of conservative non-surgical treatment appears to be validated by the lack of mortality and the high success rate (only 3 failures out of 32) in our unselected population which included polytrauma cases and patients of all ages and all types of splenic lesions. Nevertheless, shock resulting from splenic injury. In cases where bleeding is the sign of non-surgical treatment failure and in cases with acquired or induced coagulopathy and a pathological spleen, splenectomy is also indicated. Our results indicate that, when scanographic diagnosis is permanently available and when clinical surveillance is adequate, conservative non-surgical treatment can be proposed in patients with a stable haemodynamic status.

Adult↗
PubMed1995

Comparison of splenectomy effects as an indication for host response to growth of primary and metastatic tumour cells in two murine tumour systems.

The tumour-host relation is of extreme complexity; moreover, it may change during tumour progression. Information regarding this relation may be of importance in appreciating the efficiency of immunotherapy. In the present study, the effect of splenectomy on tumour growth in two murine tumour progression models, the Lewis lung carcinoma and AKR lymphoma, was examined. The effect of spleen ablation on growth of cells derived from primary and metastatic tumour cells was tested. The data obtained showed a differential effect of splenectomy on the growth of primary versus metastatic tumour cells in the two tumour systems, indicating a differential host response induced by the two cell types and/or a differential tumour cell sensitivity to immune reactions. Surprisingly, the spleen appeared to have a defensive role against metastatic tumour cells and a growth enhancing influence on primary tumour cells. The instability of the tumour-host relation may have important implications for the chances of immunotherapy to serve as an efficient cancer treatment.

Animals↗
PubMed1994

Hypertension perioperative splenectomy in thalassemic children.

We retrospectively studied the intraoperative hemodynamic changes in 100 thalassemic children undergoing general anesthesia for elective splenectomy. They were divided into 2 groups owing to the postoperative hemodynamic response. Eighty-four patients who had an unremarkable postoperative course were group 1, while 16 patients who developed immediate postoperative hypertension were group 2. There were no differences between the groups regarding age, body weight, sex, anesthetic time and operation time, except for the preoperative hematocrits of group 1 patients were slightly but significantly higher. Both groups similarly showed significant increase of the systolic as well as diastolic blood pressure throughout the anesthetic course. The heart rate was significantly increased at the beginning but declined to normal toward the end of the operation. Although none of the patients died postoperatively, all of group 2 patients needed aggressive treatment with diuretic and antihypertensive drugs. Despite the proper management, 3 of 16 patients developed convulsion and one of them had persistent neurological deficit. Since intraoperative and postoperative hypertension which commonly occur in these patients may lead to more serious neurological complications, the authors suggest that careful hemodynamic monitoring must be considered for all thalassemic children undergoing general anesthesia for splenectomy.

Child↗
PubMed1995

Laparoscopic splenectomy for massive splenomegaly: operative technique and case report.

Although laparoscopic splenectomy is the preferred technique for the elective removal of normal-sized and moderately enlarged spleens, its value in the management of massive splenomegaly has not been defined. A 33-year-old woman with massive splenomegaly was managed by laparoscopic splenectomy. The splenic vessels were embolized preoperatively to reduce operative blood loss. Laparoscopic surgery involved dissection of the suspensory ligaments at the lower pole of the spleen followed by dissection and ligation of all splenic branches near the splenic parenchyma. The operative field was explored manually through a 10-cm long Pfannenstiel incision at the public hairline, and under videoscopic control the remaining structures were safely secured. The spleen was delivered into the pelvis, fragmented and removed in large pieces. The incisions were closed after proper irrigation and laparoscopic inspection of the operative field. Further clinical evaluation is required to determine if the procedure is more efficacious than the open technique for massive splenomegaly.

Adult↗
PubMed1976

[Splenectomy for traumatic rupture of the spleen in childhood and its sequaelae].

This study was undertaken in order to assess the clinical and immunological consequences of splenectomy for traumatic reasons in childhood. Immunological testing of 22 persons 1 to 20 years subsequent to removal of the spleen for traumatic rupture between the ages of 3 and 6 revealed diminished or absent agglutinins in 10 cases and diminished or absent opsonins to E. coli in 16 cases. All patients were in good health and no clinical evidence of increased susceptibility to severe infections was found postoperatively. It is, therefore, assumed that the diagnosed defects had been compensated for by other immunological mechanisms. In contrast to the opinions of other authors, it is concluded that splenectomy in childhood between the ages of 3 and 6 does not appear to carry greater risks than in later years.

Antibodies, Bacterial↗
PubMed1993

Effects of splenectomy, devascularization and esophageal transection on portal venous pressure and portal perfusion in cirrhotic patients with bleeding esophageal varices.

This investigation sought to determine the effects of splenectomy, devascularization and esophageal transection on portal venous pressure and portal perfusion in cirrhotic patients with a previous history of hemorrhage from esophageal varices. From June 1988 to June 1991, 54 patients with liver cirrhosis underwent this nonshunting procedure for esophageal varices. Of these patients, 24 patients (20 men and four women, 39 to 68 years of age, all in Child's class A) were examined for portal pressure before, during and after the nonshunting operations. Portal venous perfusion was assessed from the venous phase of the superior mesenteric arteriogram preoperatively and one year after surgery in 16 of these 24 patients. There was no significant change (p > 0.05) in cardiac output and systemic blood pressure after the operation. The portal venous pressure before surgery was 28.4 +/- 8.0 mmHg with a range from 18 to 44 mmHg. A statistically significant decrease (p < 0.05) in the portal pressure was observed after ligation of the splenic artery (26.6 +/- 8.9 mmHg), splenectomy (24.8 +/- 8.0 mmHg), and devascularization with transection (23.4 +/- 7.5 mmHg). No correlation between the portal pressure change and splenic weight was noted (p > 0.05). Postoperative portal perfusion remained the same or even improved in 15 of these 16 patients. Only in one patient was the portal perfusion worse after the operation; this patient developed encephalopathy about 18 months later. In conclusion, a significant reduction in portal pressure is noted after nonshunting procedures but a persistent, relatively high portal pressure is maintained. Good postoperative portal perfusion can also be maintained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura.

Laparoscopy has changed our approach to various surgical problems. The technique described herein, depicted in a patient with idiopathic thrombocytopenic purpura, is safe and allows the patient to return to normal activity sooner than with open splenectomy. Laparoscopy should be considered in patients who require splenectomy for benign disease.

Adult↗
PubMed1993

Laparoscopic splenectomy: initial laboratory experience.

An experimental study was conducted in an animal model to test the feasibility of laparoscopic splenectomy. Twelve pigs were operated on. The splenectomy was feasible in 10 cases. However, a splenic injury occurred in five cases and the average blood loss was 80 ccm. We concluded that laparoscopy is feasible in an experimental model but is not a safe and easy procedure. Clinical applications should probably be limited to selected cases.

Animals↗
PubMed1994

First laparoscopic splenectomy performed in Mexico.

At Mexico City General Hospital, a 32-year-old female with autoimmune hemolytic anemia associated with cholelithiasis underwent elective laparoscopic cholecystectomy and splenectomy. The gallbladder and the spleen were delivered intact through a 7-cm extension of the umbilical trocar site. The patient was discharged in excellent condition. We describe the technique of laparoscopic splenectomy and suggest new advantages for the laparoscopic approach to surgery of the spleen.

Adult↗
PubMed1994

[Decreased interleukin-1 and interleukin-2 production after splenectomy].

Production of interleukin-1 and of interleukin-2 was measured in 57 splenectomized patients. 11 of them were after elective operations (aged 14-37 years, mean 24) and 46 posttraumatic (aged 20-36, mean 23) and in 20 appropriate controls. There was significant reduction of both interleukins in the splenectomized group, more evident in the elective group. The deficiency was not related to age of patient or time since splenectomy. These results support the view that a consequence of splenectomy is immunoregulatory deficit.

Adolescent↗
PubMed1993

Laparoscopic splenectomy: clinical experience and the role of preoperative splenic artery embolization.

We describe the clinical course of 12 patients who underwent laparoscopic splenectomy. Two patients were converted to open surgery--the first patient in the series because of a hemorrhagic incident and the eighth, who had a 34-cm spleen, because of dissection difficulties. The remaining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2-9), most patients were able to resume normal activities < or = 2 weeks. Use of preoperative splenic artery embolization was begun with the third patient. The technique involved embolization of the spleen with coils placed proximally; and contour emboli, absorbable gelatin sponge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established between operative blood loss and the percentage of splenic devascularization by preoperative splenic artery embolization (r - 0.8084). Laparoscopic splenectomy is becoming the preferred technique for elective removal of a normal sized or moderately enlarged spleen (< 20 cm long) when hematologic indications are present.

Adolescent↗
PubMed1993

[Thoracic approach for splenectomy in hematologic patients].

The article discusses the advantages of the thoracic approach in splenectomy in hematological patients. The high operative risk in patients with a marked hemorrhagic syndrome, and particularly, in the development of the Itsenko-Cushing's syndrome, is emphasized. An abdominal approach fails to ensure a safe operation in these patients. By means of topographoanatomical studies, analysis of the postoperative complications, and detailed investigation of the operative stages the authors prove the advantages of approaching the spleen through the thorax with diaphragmotomy. From experience with 226 operations for splenectomy in various diseases of the blood system, the authors showed that the number of postoperative surgical complications may be reduced by several times as compared to that in an abdominal approach.

Anemia, Aplastic↗
PubMedDate not supplied

Changes in total serum IgE concentrations after splenectomy.

In addition to allergic diseases, there are other disorders that can be accompanied by increased levels of total serum IgE. It has been demonstrated that splenectomy can alter the serum concentrations of other immunoglobulins. The aim of this study was to examine the concentrations of total IgE in the serum of patients splenectomized as a result of abdominal trauma but with no associated disease. Our results show that the average concentrations in the serum of patients were significantly higher that in the control group. Furthermore, in a large number of patients, the concentrations were above the normal limit set for the nonatopic Spanish population. These results suggest that splenectomy can alter the regulation of IgE concentrations. Since total IgE is usually determined for diagnostic purposes, it is useful to be aware of this anomaly when dealing with splenectomized patients in order to interpret correctly the laboratory analyses.

Adolescent↗