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PubMed1993

[Comparison of computed tomography results and pathological findings after laparotomy with splenectomy in Hodgkin's disease].

In 69 patients (pts) with Hodgkin's disease (HD) in I-IIIA clinical stage results of abdominopelvic computed tomography (CT) were compared with pathological staging. Concordance (specificity) of CT scan with results of macroscopic evaluation of HD lesions in the abdomen during laparotomy with splenectomy was 83%. Accuracy CT results and microscopic findings was 80%. False positive results of CT were found in 11.6% of patients and false negative in 8.6%. Specificity and sensitivity of CT versus to pathological staging were 84% and 63% respectively. The results presented here confirm, that pathological staging after laparotomy with splenectomy in HD was some advantage in precise prediction of some patients to radiotherapy and planning of irradiated fields.

Adolescent↗
PubMed1995

[Place of celio-video-surgery in splenectomy for hematologic diseases].

In order to evaluate the place of the laparoscopic approach in splenectomy for haematological disease, the authors prospectively studied a series of 25 consecutive patients requiring splenectomy. There were 11 cases of thrombocytopenic purpura, 9 lymphomas, 2 cases of herediary spherocytosis, 1 Felty syndrome, 1 idiopathic myelofibrosis and 1 Hodgkin disease. Twelve patients (48%) underwent an immediate conventional procedure for huge splenomegaly (10), obesity (1), unavailability of video-equipment. Thirteen patients (52%) underwent a laparoscopic approach. Five of these operations were converted into a conventional approach for various reasons. In the other 8 patients, the spleen was completely released laparoscopically. In two of these 8 patients, the spleen was removed via a sub-pubic Pfannenstiel incision due toits volume. The last 6 spleens (24%) were removed in a plastic bag, corresponding to 5 cases of one thrombocytopenic purpura and one Hodgkin disease. None of these patients were obese. These results suggest that the laparoscopic approach is indicated in case of moderate splenemegaly in non-obese patients.

Adult↗
PubMed1995

Does furosemide prevent hypertension during perioperative splenectomy in thalassemic children?

Hemodynamic changes of 50 thalassemic children who had splenectomy under general anesthesia were compared to 40 identical patients who, in addition, received intravenous furosemide 1 mg/kg immediate preoperation. During the anesthetic process, both groups showed a significant increase of heart rate, systolic and diastolic blood pressure more than the preanesthetic values. Hemodynamic variables in the furosemide group declined toward normal range on termination of anesthesia, whereas, the other group's variables were still significantly higher than their control. During the first 24 hours postoperatively, 20 per cent of the furosemide group had blood pressure rising higher than 130/90 mmHg, while 18 per cent was observed in the other group. Antihypertensive drugs were given to reduce the blood pressure in both groups. None of the patients in the furosemide group demonstrated any abnormal neurological symptoms, but 3 out of 50 patients in the other group developed convulsion. We, therefore, conclude that circulatory volume reduction with furosemide does not prevent hypertension during perioperative splenectomy in thalassemic children. However, it's role in prevention of neurological abnormalities needs to be further investigated.

Chi-Square Distribution↗
PubMed1995

Hand-assisted laparoscopic splenectomy.

A method of performing a laparoscopic splenectomy with the aide of intraabdominal manipulation is described. We believe that this is a versatile technique that compares quite favorably with a pure cannula approach. It is likely that this approach is safer because vascular control can readily be assured by the intraabdominal operator. It is also less costly because it is more rapid than a procedure done solely by cannula techniques. Moreover, it is reproducible by an experienced general surgeon. The results appear equal in terms of access morbidity and hospitalization time to those seen with a purely laparoscopic approach. Experience with 21 splenectomies is described and compared with 20 others performed by the traditional open approach.

Adult↗
PubMed1995

[The autotransplantation of splenic tissue after splenectomy].

The problem of spleen tissue preservation after splenectomy by means of its autotransplantation is discussed. The experimental data of the comparative assessment of spleen tissue regeneration in greater omentum, gastric wall, serous-muscle-submucosal flap of gastric greater curvature on the vascular pedicle are presented. Efficiency of autotransplantation methods and stimulation of adaptation processes after splenectomy by means of spleen tissue autotransplantation are evident.

Animals↗
PubMed1996

Serum phospholipase A2 in patients after splenectomy.

Phospholipase A2 values increase in serum in various inflammatory states, infections, and postoperatively in surgical patients. Several organs, including the liver and spleen have been suggested as sources of circulating phospholipase A2. The purpose of the present work was to examine the possible role of the spleen as a source of elevated serum concentrations of phospholipase A2 after surgery. Pre- and postoperative serum samples of patients undergoing splenectomy were studied for group I phospholipase A2, group II phospholipase A2, and C-reactive protein mass concentrations and catalytic activity concentration of phospholipase A2. The catalytic activity concentration of phospholipase A2 and the mass concentrations of group II phospholipase A2 and C-reactive protein increased postoperatively (8.08 +/- 1.40 U/l vs. 3.96 +/- 0.89 U/l (mean +/- SEM) for phospholipase A2 catalytic concentration (p < 0.03), and 154.8 +/- 32.1 micrograms/l vs. 47.5 +/- 14.7 micrograms/l (mean +/- SEM) for group II phospholipase A2 mass concentration (p < 0.02, n = 7). The mass concentration of group I phospholipase A2 remained unchanged. The catalytic concentration of phospholipase A2 correlated well with the mass concentration of group II phospholipase A2 (p < 0.001, r = 0.846, n = 43). The concentration of C-reactive protein correlated well with the mass concentration of group II phospholipase A2 (p < 0.001, r = 0.566, n = 43) in serum. The results indicate that group II phospholipase A2 is released into the circulation after splenectomy, and the spleen seems not to be the source of circulating group II phospholipase A2.

Adult↗
PubMed1996

Laparoscopic splenectomy using the harmonic scalpel.

Laparoscopic splenectomy is an accepted technique in the treatment of various pediatric autoimmune and hematologic disorders. We have employed the use of the harmonic scalpel and a posterolateral approach to improve hemostasis, ease of dissection, and decrease operative time. Four patients underwent laparoscopic splenectomy using the harmonic scalpel. Operative time averaged 1 h and 40 mm and average blood loss was less than 10 ml. Hospital stay averaged 2 days. Use of the harmonic scalpel has considerably cut our operative time and improved our patient outcomes.

Adolescent↗
PubMed1996

Laparoscopic splenectomy aided by balloon occlusion of the splenic artery: report of a case.

Laparoscopic splenectomy often involves difficulties in patients with splenomegaly because of a poor visual field and distorted and enlarged vessels secondary to the enlarged spleen. For safe and efficient laparoscopic splenectomy, we performed balloon occlusion of the splenic artery with the interventional angiographic technique in a patient with hereditary spherocytosis and splenomegaly. This new approach may be useful in terms of safety and time savings, especially in patients with splenomegaly.

Adult↗
PubMed1996

Protein A immunoadsorption column versus splenectomy in the treatment of steroid-resistant immune thrombocytopenic purpura. A cost-effectiveness analysis.

The protein A immunoadsorption column is a new treatment for immune thrombocytopenic purpura (ITP). We used a decision-analytic approach with a Markov process to model the cost effectiveness of this treatment compared with splenectomy for steroid-resistant ITP patients. Data informing the model were obtained from published literature, a panel of physicians, and public databases. We found initial treatment with the protein A immunoadsorption column to be less expensive and more effective than initial treatment with splenectomy.

Adrenal Cortex Hormones↗
PubMed1977

Hypersequestration of 51Cr-labelled erythrocytes as a criterion for splenectomy in regular hemodialysis patients.

The splenic uptake of 51Cr-labelled autologous erythrocytes was studied by body surface counting in 20 hemodialysis patients. Evidence for splenic hypersequestration of erythrocytes was obtained in 7 patients. Splenectomy was performed in 6 of these and led to a reduction in transfusion requirements. One patient without evidence of splenic hypersequestration of red cells was also subjected to splenectomy but was not improved. The importance of following the splenic uptake of 51Cr for a sufficiently long time to detect a delayed uptake of 51Cr is pointed out.

Adolescent↗
PubMedDate not supplied

Subtotal splenectomy for treatment of patients with myelofibrosis and myeloid metaplasia.

Idiopathic myelofibrosis is a chronic myeloproliferative disorder that may course with myeloid metaplasia involving several organs. Occasionally, the spleen reaches giant proportions and must be withdrawn. However, this procedure is followed by greater morbidity and mortality. Partial splenectomies, preserving the splenic pedicle, have been proposed in order to reduce postoperative complications. After an early postoperative improvement, some patients present symptomatic recurrence of their disease. This communication presents a new alternative for the treatment of complicated myeloid metaplasia: subtotal splenectomy, preserving the upper splenic pole supplied only by the splenogastric vessels. We performed this procedure in three patients. Their almost two years postoperative follow-up and health improvement suggest that this operation should be considered for the treatment of huge spleens due to myelofibrosis with myeloid metaplasia.

Adult↗
PubMed1996

Laparoscopic splenectomy.

Laparoscopic splenectomy was carried out for the treatment of patients with splenic disorders; 20 idiopathic thrombocytopenic purpura, 1 hamartoma and 3 hereditary spherocytosis. With the patients in the right lateral position, four trocars were used. Under CO2 pneumoperitoneum with a pressure of 10 mmHg, the surrounding ligaments were divided with electrocautery. At the splenic hilum, the splenic artery and vein were exposed using ultrasonic dissector. After double ligation of these vessels, the spleen was dissected with an autostapler. The resected spleen contained in a nylon bag was fragmented with finger-fracture method and extracted through a port site extended up 2 or 3 cm in length. All the patients tolerated the procedure and no blood transfusion was required. Laparoscopic splenectomy is the preferred choice to resect the spleen because of the short hospital stay, less pain and good cosmesis.

Adolescent↗
PubMed1996

[HIV infection and splenectomy: 3 cases and literature review].

3 splenectomized patients infected by the human immunodeficiency virus (HIV) are described. They all presented with more than 500 CD4/mm3 but, surprisingly, with a CD4 percentage below 15, positive p24 antigenemia and a CD4/CD8 ratio below 0.24. 2 patients had repeated episodes of oropharyngeal candidiasis while their CD4 counts exceeded 800/mm3. These episodes suggested the presence of a certain degree of immuno-suppression and prompted us to introduce anti-HIV therapy. 2 patients also presented with a pulmonary infection, due to Klebsiella pneumoniae and Haemophilus influenzae respectively. The third patient had septicemia due to Streptococcus pneumoniae type 22, despite vaccination and a CD4 count above 700/mm3. In splenectomized HIV-infected patients the number of CD4 lymphocytes should be interpreted with caution, as this number increases after splenectomy. The CD4 percentage and CD4/CD8 ratio correlated better with the clinical stage of HIV infection and gave more valuable indications as to the degree of immunosuppression. A possible correlation between viremia and the number of CD4 lymphocytes in this subset of patients remains to be established. In HIV-infected patients, infections due to S. pneumoniae, H. influenzae, S. aureus and enteric gram-negative bacteria are frequent. After splenectomy, susceptibility to encapsulated bacteria increases even in HIV-negative patients. Early vaccination against the main strains of S. pneumoniae is essential, as vaccinal response is uncertain in patients with less than 400 CD4/mm3.

AIDS-Related Opportunistic Infections↗
PubMed1996

Technique of laparoscopic splenectomy with a powered vascular linear stapler.

The spleen may be removed by a laparoscopic technique, although the benefits and associated morbidity of this approach are unknown. This study reports a series of 28 consecutive patients (15 women; median age 39 (range 17-84) years) considered for laparoscopic splenectomy, because of idiopathic thrombocytopenia in 14, human immunodeficiency virus-related thrombocytopenia in seven, autoimmune haemolytic anaemia in four, lymphoma in two and chronic lymphocytic leukaemia in one. In 23 cases dissection was completed laparoscopically, with the patient in the right lateral position, using a four-cannula technique. Vascular isolation was achieved with an Endo-GIA (powered vascular linear stapler). The spleen was removed by morselation within a retrieval bag (18 patients) or via either a Pfannenstiel or subcostal incision (five). The last 14 procedures have all been completed successfully in a mean operating time of 105 min with discharge from hospital within a median of 3 days. One patient developed a clinically apparent deep venous thrombosis 23 days after operation, for which he required readmission. Elective laparoscopic splenectomy is a feasible although technically demanding operation which may be performed safely and without associated mortality by surgeons experienced in laparoscopic techniques.

Adolescent↗
PubMed1996

Successful emergency splenectomy during pregnancy in a patient with life-threatening idiopathic thrombocytopenia. Case report.

Thrombocytopenia can be a pathophysiological feature of pregnancy. In the case reported, the thrombocyte count was reduced to 1% of normal (1 x 10(9) thrombocytes/l) at 28 weeks of gestation. In chronological order, the patient showed epistaxis, macrohematuria and gingival, conjunctival, intracerebral and pulmonary bleeding. The latter was life-threatening. An emergency splenectomy was undertaken, without complications. The operation was followed by a massive increase in the thrombocyte count, reaching 200 x 10(9)/l four days later. Unfortunately, a premature rupture of the membranes, with signs of amnion infection, occurred on the seventh day. A Cesarean section was undertaken (30 weeks of gestation), without complications. Both mother and baby are in good health 10 months later. The newborn had a normal thrombocyte count at delivery and thereafter. The life-threatening hemorrhage of the mother, the delivery of an unaffected baby and the relatively quick remission after splenectomy suggest an upregulated destruction of thrombocytes by the maternal spleen. The increased level of Macrophage-Colony Stimulating Factor (M-CSF), a normal feature of pregnancy, has the potential to augment thrombocyte destruction by activating macrophages. The production of anti-thrombocyte antibodies, especially if localized in the spleen, could result in increased thrombocyte sequestration by macrophages with severe effects focused on the mother.

Adult↗
PubMed1977

[Indication for splenectomy and exploration of the abdomen in Hodgkin's disease (author's transl)].

Splenectomies were performed on 142 patients (86 men and 56 women). The majority of them (117) were stages III or IV. The purpose of the laparotomy was therapeutic and not exploratory. Surgery was indicated, either due to evolution of the disease suggesting splenic involvement or to symptoms of hypersplenism. Splenic involvement was confirmed in 71% and hepatic involvement in 40%. Despite the risk of mortality during the first month after surgery, proportional to the extent of the disease, the overall results are encouraging provided that surgical intervention is followed by aggressive polychemotherapy. Serious infections were observed, however, in 9 patients; they did not occur for several months or even several years after splenectomy.

Abdomen↗
PubMed1997

Late postoperative follow-up of patients submitted to subtotal splenectomy.

Subtotal splenectomy preserving the upper splenic pole vascularized only by the splenogastric vessels has been performed by us in 91 patients since 1984. This procedure was combined with central splenorenal shunt or portal variceal disconnection to treating schistosomatic portal hypertension (n = 67); it was combined with distal pancreatectomy to treat pancreatic cystadenoma (n = 1), and it was carried out for severe splenic trauma (n = 14), and to control severe Gaucher's disease (n = 4) and myeloid metaplasia due to myelofibrosis (n = 5). All patients are alive. In the present paper, we present the late postoperative follow up of 32 patients operated in a period that ranges from 1 to 12 years. All patients are satisfied with the operation. Increased counts of white blood cell (n = 10) and platelets (n = 7) were the only hematological alterations. Esophageal varices were present in 23 of 27 patients operated due to portal hypertension, but all of them were shorter than in the preoperative period. The ultrasound confirmed the presence of the splenic remnant (30 of 32) without significant size changes. Splenic scintigraphies were positive in 30 of 32 patients. Subtotal splenectomy seems to be a safe procedure that can be useful in portal hypertension, some metabolic and hematological diseases, and benign growth of the distal pancreas.

Adolescent↗
PubMedDate not supplied

Splenectomy in cancer gastrectomy: recommendation of spleen-preserving for early stages.

BACKGROUND: The prognostic significance of splenectomy in cancer gastrectomy was reevaluated, in terms of postoperative survival rate, retrospectively. MATERIALS AND METHODS: The cumulative survival rates between a splenectomized group (n = 272) and a nonsplenectomized group (n = 192) were compared. RESULTS: The five-, ten- and fifteen-year survival rates were significantly higher in the nonsplenectomized group in total. When the cancer was classified, according to intraoperative gross findings of the degree of serosal invasion, penetration into adjacent organs and metastases, the five-year cumulative survival rate for Stage I and II patients was significantly higher in the nonsplenectomized group. No significant difference was found between the two groups of Stage II in any of the one- to fifteen-year survival rates. The one-year survival rate for Stage IV patients in the splenectomized group was higher than that in the nonsplenectomized group. CONCLUSIONS: The splenectomy should be limited to the Stage III or IV patients with some specific findings.

Adult↗